Does the fissureless technique decrease the incidence of prolonged air leak after pulmonary lobectomy?

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether the fissureless technique can reduce the incidence of prolonged air leak (PAL) after pulmonary lobectomy. Altogether 18 papers were found using the reported search, of which 1 prospective randomized study and 4 retrospective cohort studies represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four studies demonstrated that the fissureless technique used in pulmonary lobectomy was superior to conventional lobectomy in terms of preventing PAL and shortening the time to air leak cessation. One study showed no difference in PAL formation between these 2 procedures. The definitions for PAL as defined by duration was >5 days in 4 studies and >7 days in 1 study. Current evidence demonstrates that the fissureless technique can significantly decrease the development of PAL and time to air leak cessation after pulmonary lobectomy.