A proposal for management after lung resection, using a flexible silastic drain.

We advocate a technique using a small silastic flexible drain for air leaks after pulmonary resection. Patients undergoing lung resection by video-assisted thoracic surgery were enrolled in this study. The 331 patients consisted of 227 men and 104 women, with a median age of 58 years. The surgical procedures were lobectomy in 145, wedge resection in 177, and segmentectomy in 9. At the end of the operation, a 19F silastic drain under a pressure of -7 cm H(2)O was inserted. When no air leak was observed, we removed the drain on postoperative day 1. When an air leak was observed, the suction mode was changed to a water seal. The mean duration of chest tube drainage was 1.9 days. The chest tube was removed on postoperative day 1 in 243 (73.4%) patients. Postoperative complications, other than prolonged air leak, occurred in 5 (1.5%) patients. The drain was not effective in 4 (1.2%) patients, and it was replaced with a conventional rigid drain. Management of air leaks using silastic flexible drains is safe and effective after wedge resection. Care should be taken in cases of lobectomy and segmentectomy when a large air leak is anticipated.