Optimal management of postoperative parenchymal air leaks

Post-lung resection air leaks remain one of the most common complications resulting in delay of hospital discharge (1). They result from an alveolar-pleural fistula, and in most instances, will heal spontaneously. Prolonged air leaks (PAL) have been defined as lasting more than 5 days after surgery (2). Despite multiple advances in lung resection, including the use of stapling devices, sealants and approaches without fissure dissection, thoracic surgeons continue to be plagued by air leaks. Over 50% of patients undergoing lung resection will have an air leak within the first 24 hours after surgery (2-4) and up to 15% of patients will have a PAL (5)