Ann Thorac Surg 2006;82:1056
© 2006 The Society of Thoracic Surgeons
Original article: General thoracic
Invited commentary
Jemi Olak, MD
Department of Surgery, Lutheran General Hospital, 1875 Dempster St, Suite 145, Park Ridge, IL 60068
(Email: olakmd{at}aol.com).
There is no doubt that prolonged air leak remains one of the most common complications of lung surgery, resulting in prolonged hospital stay. This complication is particularly common not only after lung volume reduction surgery but also after lung resection for cancer because this patient population often has coexisting emphysema that predisposes them to prolonged air leaks. In two recent series, air leaks persisting more than 7 days after pulmonary resection were reported to occur in 14.8% and 15.2% of patients studied [1, 2].
Various techniques of blood patch pleurodesis have been reported in several small studies in the North American and European literature dating back to 1987 [3, 4]. In each study it has been a highly successful means of treating this frustrating complication. Success rates for stopping the air leak within 48 hours have been greater than 80%. In addition, the risk of introducing infection into the pleural space was gratifyingly low, as were other complications related to the procedure.
Why then, has this technique not been embraced by general thoracic surgeons worldwide? Perhaps it is because all studies to date have involved small numbers of patients and have been observational in nature.
The study reported in this issue of the Annals of Thoracic Surgery by Shackcloth and colleagues [5] is a small, randomized prospective trial, and the results are as encouraging as its predecessors. While our search for biologic glues to control air leaks continues, it just might be that when all is said and done, we adopt the use of autologous blood patches that are safe, efficacious, and much less costly than any biologic glue developed to date. Would the completion of a randomized clinical trial that validated the results of the smaller studies result in a change in approach to the treatment of prolonged air leak by general thoracic surgeons worldwide?
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References
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- Rice TW, Kirby TTJ. Prolonged air leak Chest Surg Clin North Am 1992;2:803-811.
- Lang-Lazdunski L, Chapuis O, Bonnet PM, et al. Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothoraxlong term results. Ann Thorac Surg 2003;70:942-947.
- Dumire R, Crabbe M, Mappin FG, Fontenelle L. Autologous "blood patch" pleurodesis for persistent pulmonary air leak Chest 1992;101:64-66.[Abstract/Free Full Text]
- Robinson C. Autologous blood for pleurodesis in recurrent and chronic spontaneous pneumothorax Can J Surg 1987;30:428-429.[Medline]
- Shackcloth MJ, Poullis M, Jackson M, Soorae A, Page RD. Intrapleural instillation of autologous blood in the treatment of prolonged air leak after lobectomya prospective randomized controlled trial. Ann Thorac Surg 2006;82:1052-1056.[Abstract/Free Full Text]
Related Article
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Intrapleural Instillation of Autologous Blood in the Treatment of Prolonged Air Leak After Lobectomy: A Prospective Randomized Controlled Trial
- Michael J. Shackcloth, Michael Poullis, Mark Jackson, Ajaib Soorae, and Richard D. Page
Ann. Thorac. Surg. 2006 82: 1052-1056.
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