Pezzer drain versus polyethylene chest tube after upper lobectomy: A randomized prospective study

Objectives: Apical residual air space and prolonged air leak are common complications contributing to prolonged hospitalization following resection of upper lobe of the lung. The objective of the study was to compare, in a prospective randomized fashion, two different management schemes for chest tubes after upper lobectomy: Pezzer drain versus polyethylene chest tube. Methods: Between 2011 and 2013, 50 patients (mean age 48.3 years) with air leaks associated with residual pleural space (3 cm at chest X-ray) persisting over 3 days after upper lobectomy were enrolled in this study. Fifty patients with air leak on the morning of the first postoperative day were randomly assigned to 2 groups: group 1 (Pezzer drain), 25 patients; or group 2 (polyethylene chest tube), 25 patients. The groups were then compared in terms of per and postoperative space, complication, hospitalization days, duration of the chest tubes, age, gender and side of the thoracotomy variables. Results: Postoperative residual space (P = 0.04) showed a significant correlation with apical polyethylene tube insertion. The Pezzer drain average duration of air leak was 3 days, the polyethylene tube average duration of air leak was 5 days. The patients with chronic obstructive pulmonary disease (COPD) in Group 2 had observed prolonged air leaks than the patients with COPD in Group 1 (P = 0.04). Pezzer drain patients showed a reduced incidence of air leak (P = 0.03), and a shorter postoperative hospital stay (P = 0.01), a shorter duration of chest tubes in place (P = 0.02). Age (more than 60 years, P = 0.029) and right thoracotomy (P = 0.01) appeared as significant predictors for apical residual air space. Empyema and pneumonia developed in 2 patients in group 2 after right upper lobectomy. Conclusions: Pezzer drain was superior to polyethylene chest tube alone in reducing the incidence of apical residual air spaces and related complications hospital stay after upper lobectomy. It is a safe, simple, cosmetic and low cost procedure.