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Ann Thorac Surg 2007;83:2259
© 2007 The Society of Thoracic Surgeons
Department of Chest Surgery, Tokushima Red Cross Hospital, 28-1 Shinbiraki Chuden-cho, Komatsushima City, Tokushima, 773-8502 Japan
(Email: sashi2000{at}mac.com).
We appreciate the kind comments of Dr Saxena and associates [1] regarding our recent article. They have highlighted two points in terms of postoperative air leakage and the use of lower lobectomy.
Postoperative air leak can be an important issue in patients undergoing chest surgery. In two of their patients an additional standard drain was inserted to manage continued air leak after surgery. We have never needed any additional drain because we have used a Blake silastic drain (Ethicon Inc, Johnson & Johnson, Somerville, NJ) and we have confirmed that absolutely no air leakage occurs during the operation. If air leakage did appear after surgery, an effective Silastic drain would resolve the problem within a week.
They pointed out that drainage after a lower lobectomy is not very effective with a single Blake drain (Ethicon, Inc) and that such patients require two standard drains including a basal drain placed over the diaphragm. In addition, they explain that the drain should be secured to the apex to keep the tube in position. They insert the Silastic drain from the basal limit of the pleural cavity and keep the tip near the apex [2]. Terzi and colleagues [3] demonstrated how they use two Silastic drains and make loops in the pleura. On the other hand, the first study mentioned in our article [4] demonstrated that the drainage capability of a Blake drain depends on its having sufficient length in the fluted part of the structure. It has become clear that the suction effect is different from that of the position (tip less than root) of the drain as designed by the creators of the Blake drain. Therefore we used the Blake drain in the pleural cavity from the front and the apex to the back and the diaphragm. The most important issue is that we insert a Blake drain in the thoracic cavity initially in the direction of the apex and posterior, and then we loop it so that the tip reaches down to the diaphragm as our article shows. We have used this Silastic drain for 2 years for 200 patients after chest surgeries, including lobectomy, pneumonectomy, wedge resection, pneumothorax, and empyema. We have never experienced any drain trouble (eg, continued air leakage or obstruction of the drain).
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