Decreasing the incidence of prolonged air leak after right upper lobectomy with the anterior fissureless technique

Objective: For major pulmonary resections, the incidence of prolonged air leak may be highest after right upper lobectomy. Dissection through an incomplete minor fissure for pulmonary artery exposure may contribute to air leak. We evaluate the efficacy of the anterior fissureless technique in decreasing the incidence of prolonged air leak after right upper lobectomy. Methods: Twenty-seven consecutive patients had right upper lobectomy by the classic technique of fissure dissection for pulmonary artery exposure (group A). The next 66 patients had right upper lobectomy by the anterior fissureless technique (group B). Results: During the period of group A, we observed a higher incidence of prolonged air leak [22.2% (6/27) vs 6.5% (3/46), P-.049] and an increase in hospitalization days (mean 14.8 vs 8.7 days, P-.021) after right upper lobectomy as compared with all other lobar resections. Comparing the 2 techniques for right upper lobectomy (group A vs group B), there was no difference in patient characteristics, operative characteristics, morbidity, or mortality. However, there was a difference in the time to air leak cessation (log-rank P = .002), incidence of prolonged air leak [22.2% (6/27) vs 7.6% (5/66), P = .047], days with chest tube (mean 9.7 vs 6.6 days, P = .044), and days in hospital (mean 14.8 vs 8.2 days, P = .001) favoring group B. No other factors predicted prolonged air leak after right upper lobectomy. Conclusions: The anterior fissureless technique decreases the duration of air leak, incidence of prolonged air leak, days with chest tube, and days in hospital without any noted disadvantages. This technique should be considered when performing right upper lobectomy. (J Thorac Cardiovasc Surg 2010;139:1007-11)