Management of Postoperative Air Leaks in Thoracic Surgery: Comparative Efficacy of Digital Drainage, Pleurodesis and Sealant Strategies.

¹Dr Tahir Aslam, Prof Dr ²Muhammad Parvez, ³Dr. Aman Ullah, ⁴Dr Shahzada Amir Ahmed Babar, ⁵Dr Muhammad adeel, ⁶Dr Abdulsattar Abro

¹Assistant Professor Thoracic Surgery Fatima Jinnah Institute of Chest Diseases Quetta.

²HOD Surgery Fcps- General surgery Fcps- Thoracic surgery Wah medical college, Wah Cant.

³FCPS, general surgery Pakistan Petroleum Limited Sui field hospital, Sui Balochistan.

⁴Associate professor general surgery bolan medical college quetta.

⁵Senior registrar General surgery Alnafees medical college and hospital Islamabad.

⁶Associate Professor G.Surgery Chandka Medical College Larkana SMBBMU.

Background: Postoperative air leak is one of the most frequent complications after pulmonary resection. Persistent air leaks prolong chest tube duration, delay recovery and increase hospital costs. Several innovations—including digital chest drainage systems, pleurodesis and sealants—aim to improve outcomes, yet comparative evidence remains inconsistent.

Aim: To synthesise contemporary evidence and analyse local data comparing digital drainage, pleurodesis and sealant strategies for managing postoperative air leaks after thoracic surgery.).

Methods: A retrospective analysis of 120 thoracic surgery patients (Jan 2023–Mar 2024) was performed, examining air leak duration, risk factors, and interventions. A structured survey was conducted among 10 clinicians and 10 patients to explore management practices and discharge preferences..

Results: PAL (>5 days) occurred in 33% of patients, significantly associated with age >65, COPD, and BMI <23. Digital drainage systems reduced leak duration compared to analogue systems (3.2 vs. 5.1 days, p<0.001). Early ambulation shortened hospital stays. Only 10% of patients were discharged with portable suction, though 70% of clinicians favored this. Most patients expressed willingness for early discharge if properly educated.

Conclusion: Risk-based PAL management using digital systems and early mobility improves outcomes. Adoption of outpatient protocols remains low despite clinician support and patient openness. Standardized discharge planning and broader use of portable systems are recommended

Keywords: postoperative air leak; thoracic surgery; digital drainage; pleurodesis; sealant; autologous blood patch; fibrin glue; prolonged air leak. Prolonged air leak, thoracic surgery, digital drainage, outpatient management, pulmonary resection