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Ann Thorac Surg 2007;84:1074-1075
© 2007 The Society of Thoracic Surgeons

Correspondence

Monaldi’s Intracavitary Decompression and Its Modifications

Balamurali Srinivasan, MCh, Suvakanta Biswal, MCh, Harkant Singh, MCh, Shyamkumar Singh Thingnam, MCh

Department of CVTS, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India

(Email: eazzyryder{at}yahoo.com).

To the Editor:

We read with interest the technique described by Stewart and colleagues [1] for decompressing a giant bulla. However, the authors’ claim to be the first to describe such a technique is incorrect. Monaldi [2] described the technique of intracavity suction and drainage for the treatment of tuberculous abscess cavities to relieve the tension within the cavity. This method was first adapted in the treatment of emphysematous bulla by Head and Avery [3]. However this procedure was performed in two stages to decrease the risk of pneumothorax; the first stage produced pleural adhesions using iodine packs and the second stage drained the bulla. It was Macarthur and Fountain [4] who first used a Foley’s catheter for intracavity suction and drainage of an emphysematous bulla. In this technique a small incision was made over the area where the bulla was closest to the visceral pleura. A 2.5-cm section of rib was excised subperiosteally and a pursestring suture was placed holding the layers of the pleurae and the bulla together. A Foley’s catheter was passed through the pursestring and connected to an underwater seal (Fig 1).


Figure 1
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  		Fig 1. Modified Monaldi’s technique: Foley’s catheter through a pursestring on walls of pleura and bulla.

 
The Brompton technique also used a Foley’s catheter, but it also insufflated the cavity and the pleural space with talc for rapid pleurodesis and fibrosis of cavity [5].

All these techniques have used the Foley’s catheter as a self-retaining intracavity drainage catheter that anchors the bulla to the chest wall thereby preventing pneumothorax. It is noteworthy that these authors did not label their technique as a temporizing method as did Stewart and colleagues [1]. Nevertheless, they claim it to be safe, simple, and effective treatment for high-risk patients with poor respiratory reserve [4, 5].


   References
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 References
 

  1. Stewart NM, Saxena P, Newman MA, Konstantinov IE. Decompression of giant bulla in acute pneumonia: surgical palliation prior to definitive management Ann Thorac Surg 2006;82:2308-2309.[Abstract/Free Full Text]
  2. Monaldi V. Endocavitary aspiration: its practical applications Tubercle 1947;28:223-228.[Medline]
  3. Head JR, Avery EE. Intracavitary suction (Monaldi) in the treatment of emphysematous bullae and blebs J Thorac Surg 1949;18:761-776.[Medline]
  4. Macarthur AM, Fountain SW. Intracavity suction and drainage in the treatment of emphysematous bullae Thorax 1977;32:668-672.[Abstract/Free Full Text]
  5. Shah SS, Goldstraw P. Surgical treatment of bullous emphysema: experience with the Brompton technique Ann Thorac Surg 1994;58:1452-1456.[Abstract]

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Igor E. Konstantinov, Mark A.J. Newman, and Pankaj Saxena
Ann. Thorac. Surg. 2007 84: 1075. [Extract] [Full Text] [PDF]



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