PURPOSE: Drainage of the pleural space after video-assisted thoracotomy (VATS) is traditionally accomplished by tube thoracostomy utilizing semi-rigid plastic drainage tubes connected to a three-chamber collection system. Another option gaining popularity is the utilization of smaller, flexible, silastic drains (Blake®). Limited data exists to support the non-cardiac use of these drains. We plan to explore the utility and safety of a less utilized pleural drainage system with Blake tube drainage and bulb suction, without the use of the traditional three-chamber system.
METHODS: We conducted a retrospective review of patients undergoing VATS with talc pleurodesis. The procedures were performed by one surgeon (U.D.) and post-operatively subject to the following thoracostomy drainage system: Two 19 French Blake drainage tubes into the pleural space, each connected to a bulb drain, which were then connected to wall suction. The wall suction was utilized to induce flattening of the bulb and augment drainage. We reviewed the incidence of post-operative complications (air leak, re-operation rate secondary to chest tube malfunction, duration of thoracostomy, and mortality).
RESULTS: Twenty patients underwent VATS with pleurodesis for recurrent pleural effusion. All patients received post-operative pleural drainage with tube thoracostomy as described above. No patient required re-operation. All signs of pneumothorax were resolved by post-operative day #1. The average length of thoracostomy drainage was 4.9 days (Range: 2–13 days). Two patients died post-operatively, however, prior to their deaths had been transferred to palliative care. Both patients had metastatic cancer (lung, renal) and the procedure was attempted for palliation. The deaths did not appear directly related to the procedure.
CONCLUSION: Minimal complications were discovered on retrospective review of patients utilizing the described Blake pleural drainage system. This study demonstrates the efficacy and safety of this pleural drainage system.
CLINICAL IMPLICATIONS: This retrospective review demonstrates the safety and efficacy of Blake pleural drainage tubes without the traditional three-chamber collection system. A randomized trial to confirm these findings along with this systems’ ability to detect pneumothorax should be undertaken.
DISCLOSURE: Christopher Gilbert, None.