"Stripping" to prevent prolonged air leak; is there a future in the past?

Background: A number of technical precautions and many synthetic or biological materials have been suggested to reduce the frequency of prolonged air leak (PAL) following lung resection. Preserving the three-dimensional properties of the remaining lung parenchyma may prevent this complication to some extent. This study presents our experience with an old technique called "stripping" for the division of incomplete fissures to preserve the original shape of the remaining lung with the hope that this will minimize PAL-related problems. Methods: 262 consecutive patients with incomplete fissures underwent lobectomy or bilobectomy. Stripping was employed for the division of incomplete fissures in Group S (Study arm; n = 148) and a cut-and-sew technique or staplers were used in Group C (Control arm; n = 114). To evaluate a possible learning curve effect with this technique, Group S was further divided into two subgroups, designated the initial experience (Group S(IE)) and the late experience group (Group S(LE)) and consisting of the first 1/3 (n = 50) and remaining 2/3 (n = 98) of patients, respectively. The frequency of PAL and other related morbidities were investigated. Results: Morbidity and mortality rates were comparable between Group S and C (10% vs. 8.7% and 2% vs. 2.6%; p = 0.83 and p = 0.96), as was the frequency of PAL, which occurred in 12 (8.1%) and 13 (11.4%) patients (p = 0.40), respectively. When each of the subgroups was compared with Group C, PAL occurred in 9 (18%) patients in Group SIE (p = n.s.) but only in 3 (3%) patients in Group SLE (p = 0.03). There was also more postoperative persistent air space in Group C, without this difference reaching statistical significance. Conclusion: This study suggests that preservation of the original shape of the remaining lung might decrease the incidence of PAL in patients with relatively healthy lung tissue. An actual favorable effect of stripping over other techniques emerges only when the technique is precisely applied, which is only possible with experience.