Prospective evaluation of vacuum pleural drainage after thoracotomy in patients with esophageal carcinoma

Abstract

Objective: To evaluate the safety and efficacy of vacuum pleural drainage systems in selected patients. Design: Prospective nonrandomized study. Setting: Division of Upper Gastrointestinal Surgery at a tertiary care center. Patients and Intervention: Between January 1, 1995, and December 31, 1995, 32 patients underwent a right-sided posterolateral thoracotomy for the resection of esophageal carcinoma. A vacuum drain was employed in 21 patients (group 1) and an underwater drain in 11 patients (group 2). The selection of patients for vacuum drainage was based on minimal pleural adhesions and technical ease of the operation. Main Outcome Measure: Data on drainage efficiency, total drainage output and duration of the drain being left in situ, and postoperative pulmonary complications were analyzed. Results: The median total drainage outputs were 1280 mL and 1230 mL (P=.92, Mann-Whitney U test) in groups 1 and 2, respectively, and the median duration of chest drains being left in situ was 7 days and 6 days (P=.11, Mann-Whitney U test) in groups 1 and 2, respectively. Postoperative pulmonary complications occurred in 5 patients (24%) enrolled in group 1 and 5 patients (45%) enrolled in group 2 (P=.09, Fisher exact test). No hospital mortality was reported during the study. Conclusion: The vacuum drain has proved to be as safe and efficient as the traditional underwater drain, imposing less discomfort and allowing early mobilization. The vacuum drain is, therefore, recommended in selected patients undergoing thoracotomy for esophageal resection.