Effective Management of Persistent Pneumothorax Using a Thopaz® Digital Drainage System Combined with an Endobronchial Watanabe Spigot

Successful treatment of post-operative peripheral bronchopleural fistulas using endobronchial Watanabe spigots

Post-operative peripheral bronchopleural fistulas (BPF) are sometimes caused by post-operative pneumonia and empyema. Conservative treatment options such as administration of antibiotics and chest tube drainage can have limited outcomes in certain cases. Bronchial occlusion is an effective treatment option if the target bronchi for BPF are identified. This case study describes a successful bronchial occlusion for peripheral BPF with endobronchial Watanabe spigots (EWSs) and a digital drainage system. This case involved a 70-year-old man who developed a post-operative peripheral BPF after a left upper lobectomy. Bronchial occlusion with EWS was performed because the target bronchi responsible for BPF were clearly detected by a chest computerized tomography scan. The effectiveness of the occlusion was confirmed with the use of a digital drainage system immediately after the procedure was completed. The chest tube was removed one week following the bronchial occlusion procedure.

Digital thoracic drainage: a new system to monitor air leaks in pediatric population

INTRODUCTION

New digital thoracic drainage systems allow an objective measurement of air leakage. They have proven their usefulness in the postoperative thoracic surgery in adults, but there is little experience with its use in the pediatric population. The objective of our study is to analyze their safety and effectiveness in the postoperative period of the pediatric patients.

METHOD

A prospective consecutive observational study was done. All patients submitted to pulmonary resection between 2011 and 2017 and in whom digital thoracic drainage system was used (Thopaz Chest Drain System, Medela, Switzerland) were prospectively enrolled in this study. We analyzed variables: duration of chest tube (CT), days of hospitalization and radiographs in the immediate postoperative period related to the presence of CT. This group was compared with a historical cohort of patients (from 2011 to 2015) with a pulmonary resection in whom the traditional thoracic drainage was used. For the statistical analysis, the Mann-Whitney U-Test was used for independent samples.

RESULT

Twenty-six patients were included, Digital drainage system was used in13 patients and traditional drainage was used in 13 patients. The median age was 18 months (12 days-14 years). The mean number of days with the chest tube was 1.69 ± 0.6 in digital drainage group versus 5.38 ± 4 days in traditional drainage group (p < 0.05) The mean number of postoperative radiographs was 2.8 ± 1.1 in digital drainage group versus 6.23 ± 5.2 radiographs in traditional drainage group (p < 0.05). The average hospital stay in digital drainage group was 5.69 ± 2.7 days versus 7 ± 4.7 days in the traditional drainage group (p > 0.05). No complications related to the use of digital drainage group were registered.

CONCLUSION

The digital thoracic drainage systems provide an objective measurement of air leakage, allowing early chest tube removal and decreasing the number of radiographs performed postoperatively. Its use in the pediatric population appears to be safe and potentially beneficial.

LEVEL OF EVIDENCE

II.

[Application of Digital Drainage System in Postoperative Refractory Prolonged Air Leaks after Pulmonary Surgery]

背景与目的

术后持续性肺漏气是肺部手术后最常见的并发症之一。数字化胸腔引流系统（digital drainage system, DDS）被认为具有准确、客观、舒适、患者耐受性好、经济等优点。本研究旨在总结DDS用于肺部手术后难治性持续性大量漏气的临床疗效。

方法

术后5天和7天分别是胸腔镜和开胸术后持续性肺漏气（prolonged air leak, PAL）的界限；本研究将难治性持续性大量漏气定义为达到PAL时间2倍及以上且漏气持续达2度以上，可伴有明显皮下气肿或纵隔气肿等相关并发症。2016年1月-2016年12月间，应用数字化胸腔引流系统结合胸膜固定术治疗符合上述标准的病例共8例，收集相关临床资料并总结分析。

结果

本组病例中肺叶切除术6例，肺段切除2例。平均术后持续漏气（17.3±5.1）d，DDS平均使用时间（5.6±3.7）d。平均术后引流量（3, 550.6±1, 881.1）mL。应用DDS前后的平均引流量为（2, 615.6±1, 741.2）mL和（935.0±242.7）mL。平均住院时间（18.1±5.0）d。

结论

数字化胸腔引流系统用于肺部手术后难治性持续性大量漏气安全可行，可提供更大的负压吸引值，从而促使患肺复张为后继的胸膜固定术创造条件，并缩短引流天数和住院时间。

Evaluation of a digital drainage system (Thopaz) in over 250 cases at a single site: A retrospective case-control study

PURPOSE

The aim of this study was to evaluate the efficacy of the Thopaz system, a new drainage system in management of general thoracic surgery, based on a review of our clinical practice and a comparison of the utility of the Thopaz device compared with a standard drainage system.

METHODS

A review of 540 thoracic surgeries at our hospital was performed. These cases were divided into 275 treated with the Thopaz system from April 2014 to March 2015 and 265 treated with a standard system from April 2013 to March 2014. The characteristics of patients and outcomes after surgery were compared in these 2 groups.

RESULTS

The characteristics of the patients were similar in the 2 groups. Outcomes after surgery, including types of operation, period of chest tube placement, chest tube reinsertion rate and clamping test rate also did not differ significantly between the groups.

CONCLUSIONS

The non-inferiority of the Thopaz system compared to a standard system was verified statistically. With advantages of providing objective data as a small portable system, in addition to the quietness of the unit and the ease of setup and operation, Thopaz system is likely to become mainstream in postoperative management in general thoracic surgery.