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P222 Evaluation of drainage and closure methods following local anaesthetic thoracoscopy (LAT): a multi-centre analysis of complications and outcomes
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P222 Evaluation of drainage and closure methods following local anaesthetic thoracoscopy (LAT): a multi-centre analysis of complications and outcomes
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P222 Evaluation of drainage and closure methods following local anaesthetic thoracoscopy (LAT): a multi-centre analysis of complications and outcomes
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Journal Article
P222 Evaluation of drainage and closure methods following local anaesthetic thoracoscopy (LAT): a multi-centre analysis of complications and outcomes
2025
Overview
IntroductionLocal Anaesthetic Thoracoscopy (LAT) is a well-established procedure for evaluating unexplained exudative pleural effusions. The standard approach involves the insertion of a chest drain post-LAT, connected to an underwater seal to facilitate lung re-expansion and reduce the risk of surgical emphysema (SE).Alternative techniques include placement of a long-term indwelling pleural catheter (IPC) when indicated, connected to an underwater seal or capped, as well as primary closure of the LAT incision without drainage.AimTo evaluate different methods of incision closure and drainage following LAT, and to assess associated complications.MethodsRetrospective review of 289 patients undergoing LAT between 2022 and 2024 across three UK centres.ResultsMean age 71.5 years (range 33–92); 222 (76.8%) males. LAT was performed as a day-case procedure in 246 patients (85.1%). 31 (10.7%) had large bore drain insertion removed prior to discharge; 175 (60.6%) had IPC connected to an underwater seal until discharge; 39 (13.5%) had a capped IPC with no drainage and 44 (15.2%) had primary incision closure without drainage.6 (2.1%) intraoperative complications, none related to drainage or closure methods. 19 (6.6%) had post LAT complications within 30 days.Of the 175 with post LAT IPC and underwater seal, 3 (1.7%) had local infection, 1(0.57%) had pneumonia, 4 (2.3%) had ongoing air leak or clinically significant surgical emphysema requiring admission; 3 (1.7%) had blocked IPC and 2 (1.1%) had complications unrelated to drainage method.Of the 83 who had primary closure with or without capped IPC, 3 (3.6%) had clinically significant surgical emphysema, 1 (1.2%) slow to re-expand lung,1 (1.2%) local infection and 1(1.2%) complication unrelated to drainage method. There were no deaths related to LAT.Abstract P222 Figure 1[Image Omitted. See PDF.]ConclusionsOur study demonstrates that various drainage and incision closure techniques following LAT, performed as day-case procedures, are generally safe and associated with low complication rates. The less conventional approach - primary incision closure and no drainage – does not appear to increase the risk of clinically significant surgical emphysema (SE) compared to post LAT drainage with either a short-term chest drain or IPC. Further prospective studies are warranted to compare these techniques.
Publisher
BMJ Publishing Group LTD
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