Have Water Seal Drainage Systems Come to an End?

Mithat Fazlioglu; Walid Hammad; Deniz Piyadeoglu; Cemal Asim Kutlu

Mithat Fazlioglu Tekirdag Namik Kemal University, Medical Faculty Department of Thoracic Surgery, Tekirdag, Turkey
Walid Hammad Department of Cardiothoracic Surgery, Al-Azhar Faculty of Medicine, Cairo, Egypt
Deniz Piyadeoglu Bahcesehir University, School of Medicine, Department of Thoracic Surgery, Istanbul, Turkey
Cemal Asim Kutlu Bahcesehir University, School of Medicine, Department of Thoracic Surgery, Istanbul, Turkey

Keywords: Low auto-suction drain, Seal-suction test, Underwater seal

Abstract

Background: We hypothesized that underwater seal drains are not mandatory after thoracic procedure when the visceral pleura remains intact. A small size drain with low auto-suction system (e.g., Hemovac) may be sufficient if no evidence of air leak.

Methods: This is an observational study on using low auto-suction drain as a solo pleural drain after thoracic procedures in which visceral pleura remained intact at the end of surgery. After completion of the procedure on the selected Cohort of patients, 10F Hemovac drain was inserted and fixed using 4/0 silk suture. Small collection bag, 250cc, was connected. To ensure tight wound closure around the small caliber drain, a tunneled insertion techniques using valve mechanism for at least one intercostal space was used. Finally, by the end of the procedure, Seal/Suction test should be utilized to test for the presence of air leak either from around the drain site or disintegrated visceral pleural surface. The primary outcomes were to detect the feasibility of low-suction drain after selected thoracic procedures. The secondary outcomes were to monitor the incidence of postoperative complications related to drainage system in the short term.

Results: the low-suction drain was used in 125 patients ranging between 4-86 years old. The drain was removed by the end of postoperative day 1 in 76%. Only 8 patients (6.4%) required drainage longer than 48 hours. Small apical air space (< 2cm) was detected on the immediate postoperative chest X-ray in only 8 patients (6.4%). Minimal pleural fluid was seen on the follow-up x-ray at one week in the outpatient clinic in 16 patients (%12.8). None of the patients required insertion of a chest drain or thoracocentesis. No complication related to using the Hemovac drain was reported.

Conclusion: Our observations suggest that low vacuum drainage systems are a feasible alternative to water-seal drainage systems in the remarkable number of thoracic procedures. This safe and practical drainage system could pave the way towards drainless surgery which is a culminating level for thoracic surgeons.