J.Jpn. Surg. Soc.. 57(9): 1494-1512, 1956

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STUDY OF POSTTHORACOTOMY INTRACIC DRAINAGE

It has been not infrequent to encounter difficulties with intrathoracic drainage following thoracic surgery because of sealing off the drain at an early postoperative date. In addition, consecutive thoracocentesis required in such occasion is always accompanied by a risk of puncture of the important organs in the thorax as well as by shortcoming of its troublesome manipulation.
In order to resolve such problems, a study has been continued on improvement of the intrathoracic drainage following esophageal surgery. At the beginning of our experience, a rightangle or T-form rubber tube was employed. In the long run, we could find out a clue to resolve these problems. In other expression, it was noted that these difficulties were almost completely resolved by instillation of new drainage consisting of polyethylene tube and of a polyethylene film attached near a tip of the tube. Comparison of this new drain with the conventional ones revealed the following features.
1) A maximum amount of drainage is secured by the polyethylene system, whereas a less amount of drainage and early sealing off of the tube are the common events in the rubber system.
Therefore, the latter often entails excution of thoracocentesis or re-establishment of drain. The most common place where the effusion is apt to accumulate in such occasion is the retromammary intrapleural space. It has been quite common that sufficient drainage from such place is not obtainable with two rubber tubes. On the contrary, polyethylene drainage system has seldom encountered the necessity of thoracocentesis.
2) The period of drainage action is so prolonged by the polyethylene drainage that sufficient effect is obtained, which makes a distinct contrast with the conventional drainage which is sealed off within thirty hours.
3) Observation was done, for a postoperative period, on the total amount of effusion coming out by both intrathoracic rubber tube pluse thoracocentesis. Regradless of the sort of the drainage, it was found that its amount presented a diphasic curve with the second sumit on the 5th or 6th postoperative day. From this fact, it will be easily understood why so frequently the necessity of thoracocentesis occurred after early withdrawal of the rubber tube which is sealed off as early as about the third postoperative day.
4) No pyothorax followed esophageal surgery since the new drainage system has been employed, whereas five patients ever submitted to this nasty complication before the advent of the polyethylene drainage.
5) Polyethylene tube, being almost transparent, enables us to notice the effusion drained in nature and color. No stillstand of drainage action due flexion of the polyethylene tube was noted.
Thus polyethylene drainage is of distinct value among various modes of the intrathoracic drainage.
(author's abstract)

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