Transhiatal chest drainage following minimally invasive esophagectomy

Tairo Ryotokuji, Yosuke Izumi, MD, PhD, Michiyo Tokura, MD, Akinori Miura, MD, PhD, Tsuyoshi Kato, MD, Kei Sakamoto, MD

Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital

BACKGROUND: Patients following esophagectomy often requires left chest tube drainage on the 3 or 4 postoperative day due to pleural effusions in the contralateral thoracic cavity of the right transthoracic procedure. Transthoracic intercostal drain placement is standard practice. However these chest tubes cause pain and hamper mobility, sometimes causing pulmonary complications and delaying recovery. In patients following minimally invasive esophagectomy (MIE), these drains sometimes ruined the advantage of MIE. We introduced a novel transhiatal drainage for postoperative left pleural effusions.

AIM: The aim of this study is to investigate whether transhiatal chest tube drainage is effective and safe following minimally invasive esophagectomy.

METHODS: Between September 2005 and August 2012, 77 patients underwent MIE. We placed 28Fr intercostal chest tube for right thoracic cavity and transhiatal silastic drain for left thoracic cavity intraoperatively in 42 patients without left subphrenic abdominal drainage (Group A). We placed 28Fr intercostal chest tube for right thoracic cavity and left subphrenic drainage tube in the abdomen in 35 patients (Group B).

RESULTS: No patient developed clinically significant pleural effusions in the left thoracic cavity, requiring further drainage in Group A. 25 patients (71%) required additional drainage in the left thoracic cavity in Group B. No complicatins were noted, associated with transabdominal chest tube and no drain for abdominal cavity in Group A.

CONCLUSION: Transhiatal chest tube drainage of the left pleural cavity is an effective and safe means of draining the chest, following minimally invasive esophagectomy. Elimination of additional intervention after MIE would have the not a little advantage of faster recovery of the patients. This technique can also be applied to open transthoracic esophagectomy.

Session: Poster Presentation

Program Number: P264

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