Prolonged Air Leak in Lung Surgery: Does it demand a prophylactic approach?

According to the clinical literature air leaks occur in resective lung surgery in approximately 70% of cases. Of these, more recently it has been reported that 57% are grade 2 or 3. It’s also frequently reported that approximately 10% will develop into prolonged air leaks(PAL). So given the lack of perfect correlation between intraoperatively assessed grade 2/3 leaks and later PAL, does this mean that all grade 2/3 leaks identified post-resection during surgery should be treated as though they are potential candidates for enduring leakage? As usual it’s difficult to be definitive. No surgeon would close a chest with a significant air leak, so the population is skewed by the surgeon’s efforts to level the playing field by minimising identifiable leaks. Does the 10% of PAL correlate with the 10% of cases graded as 3 intraoperatively? If yes, one would seriously question the quality or method of repair. Without detailed data it is very difficult to confidently correlate intraoperatively assessed leak grade with prediction of PAL. There is unlikely to be one key determining factor in selection of patients for additional adjunctive measures to reduce PAL. Propensity seems to be multifactorial, including initial leak grade and quality of repair among others. Obviously Tissuemed exists because leaks exist, which means the company is keen to be involved in the management of those leaks, but equally the company cannot entertain bad science or non evidence based practices. The jury is definitely out when it comes to adoption of a protocol to guide the use adjunctive measures to seal leaks, but what does come across loud and clear in our post-marketing data collection is that TissuePatchThoracic is an extremely effective and easy to use solution, albeit to a moving target.