Prophylactic Intraoperative Pneumoperitoneum Decreases Pleural Space Problems after Lower Lobectomy or Bilobectomy of the Lung

Background: Following lower lung lobe resection, prolonged air leaks and residual pleural space are common. We investigated whether an artificially induced prophylactic intraoperative pneumoperitoneum would prevent these complications. Method: Sixty patients Who underwent lower lobectomy or bilobectomy were prospectively randomized into 2 groups according to the use of intraoperative pneumoperitoneum. Air was delivered via a catheter placed under the diaphragm in the pneumoperitoneum group. Parameters related to pleural drainage, complications, and hospital stay were compared. Results: No difference between the preoperative characteristics of both groups was present. The mean duration of chest tube drainage was shorter (3.47 +/- 1.04 days vs. 4.87 +/- 1.43 days, p < 0.001) and the mean amount of chest drainage was lower (305.0 +/- 76.9 ml vs. 488.3 +/- 215.2 ml, p < 0.001) in the pneumoperitoneum group. Residual pleural space was observed in 1 pneumoperitoneum patient (3.3%) and in 8 controls (26.7%). Pneumoperitoneum patients were discharged 1.1 days earlier on average than the controls. Conclusion: Artificial prophylactic intraoperative pneumoperitoneum is a simple and safe procedure that decreases the postoperative amount of fluid drainage, residual pleural space, duration of chest tube drainage, and hospital stay.