The approach of fused fissures with fissureless technique decreases the incidence of persistent air leak after lobectomy

Objective: To evaluate two different approaches used to perform fused fissures in lobectomies in terms of persistent air leak (PAL) and their impact on length of hospital stay. Methods: One hundred and nineteen patients underwent lobectomy or bilobectomy in our unit. We focused on patients with fused fissures (63 patients), all of whom were selected intraoperatively based on predefined criteria. These patients with incomplete fissures were randomly assigned to two groups: Group A patients who underwent a ‘traditional technique’ to approach fused fissures and Group B patients who underwent a ‘fissureless technique’. The latter technique avoids dissecting the lung parenchyma over the pulmonary artery, reducingthe chancesof air leak. Patients in both groupshad shown no significant difference in preoperative variables(p > 0.05).Results: The incidence of PAL was significantly higher among patients with incomplete or fused fissures (0 case vs 8 cases (Groups A and B), p < 0.005). Furthermore, the incidence of PAL was significantly higher in the Group A (traditional technique) (7 vs 1) (p < 0.05, OR = 3.1, CI 0.22—0.51). The probabilityforairleakcessationwassignificantlyhigherinpatientsofGroupB(fissurelesstechnique)(logrankp < 0.0001).Thelengthofhospital stay was higher in Group A (5.76 3.1) compared with Group B (4.9 1.7) (p < 0.05). No other variables were identified as risk factors for PAL in this series. Conclusions: The fissureless technique appears to be a superior approach for fused fissures in terms of both preventing persistent air leak and reducing the length of hospitalisation. This technique can be performed safely at no additional cost and without adverse consequences. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.