BACKGROUND
Chest drainage following oesophagectomy is used to treat pneumothoraces and pleural effusions. Transthoracic intercostal drain placement is standard practice.1-3 We describe a novel transabdominal technique for placement of large bore chest drains for pleural, mediastinal, and abdominal drainage following oesophagectomy.
TECHNIQUE
Over a 6-month period, size 28 French gauge tubes were inserted via the hypochondrium to the upper thoracic cavity at the time of oesophagectomy. Digital pleural puncture was carried out prior to drain insertion if it had not occurred during resection and postoperative chest X-rays confirmed correct tube position. Drains were removed after 4–7 days when output reduced to approximately 100 ml/day. Re-accumulation of pleural effusions was managed with percutaneous, small-bore intercostal chest drains placed under ultrasound guidance.
DISCUSSION
Our study group included 32 patients. Complications occurred in 5 patients (15.6%), including re-accumulation of pleural effusion (12.5%) and drain displacement (3.1%). No residual pneumothoraces were observed. There were no intra-operative or postoperative deaths. Transhiatal chest drains inserted intra-operatively reduce the risk of lung parenchymal laceration or haemothorax, and obviate the need for separate abdominal drains. In addition, the longer drain tract, in theory, reduces the risk of ascending infection. Potential disadvantages including tract tumour seeding, risk of abdominal visceral laceration, drain kinking and erosion into mediastinal structures. However, this technique appears to be a safe and effective method of thoracic drainage post oesophagectomy. A large, randomised, controlled trial is required to assess fully the benefits and limitations of transhiatal chest drains.
References
- 1.Laws D, Neville E, Duffy J, the British Thoracic Society Pleural Disease Group BTS guidelines for insertion of a chest drain. Thorax. 2003;58(Suppl II):ii53–9. doi: 10.1136/thorax.58.suppl_2.ii53. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Gossage JA, Chukwuemeka AO, Dussek JE. Intercostal drain migration post esophagectomy. Dis Esophagus. 2003;16:268–9. doi: 10.1046/j.1442-2050.2003.00343.x. [DOI] [PubMed] [Google Scholar]
- 3.Law S, Boey J-P, Kwok K-F, Wong K-H, Chu K-M, Wong J. Pleural drainage after transthoracic esophagectomy: experience with a vacuum system. Dis Esophagus. 2004;17:81–6. doi: 10.1111/j.1442-2050.2004.00380.x. [DOI] [PubMed] [Google Scholar]