Comparison of clinical efficacy of three different drainage strategies after thoracoscopic lobectomy in patients with complete pleural adhesions

There are no standard guidelines regarding the postoperative drainage strategies for patients with complete pleural adhesions undergoing thoracoscopic lobectomy. This study aimed to observe and compare the clinical drainage effects of three drainage strategies in these patients after thoracoscopic lobectomy. A total of 90 patients who underwent thoracoscopic lobectomy with complete pleural adhesions at our hospital between January 2022 and December 2024 were selected. Based on the drainage method, they were divided into three groups: Group A (28 F+28 F silicone tube double drainage, n = 23), Group B (28 F silicone tube single drainage, n = 39), and Group C (28 F silicone tube + 8 F pigtail catheter double drainage, n = 28). The total thoracic drainage volume, duration of thoracic drainage tube placement, duration of 28 F drainage tube placement, postoperative hospital stay, Visual Analogue Scale(VAS)at 24 h, 48 h, and 72 h postoperatively, number of emergency analgesic injections postoperatively, postoperative complications, and rate of reinsertion were compared among the three groups. Groups B and C had shorter drainage tube indwelling time than Group A (6.36,6.18 vs. 10.00 days, p = 0.005), with Group C showing the shortest 28 F tube duration (4.36 ,6.36 vs. 10.00 days, p < 0.001). Postoperative hospital stay was reduced in Groups B and C compared to Group A (7.51,6.29 vs. 11.13 days, p = 0.004). Groups B and C had lower VAS scores at 24 h (2.90,2.36 vs. 4.78, p = 0.002) and 48 h (3.87,3.32 vs. 5.09, p = 0.040), and required fewer analgesic injections (0.95,0.39 vs. 1.39, p = 0.045).The re-catheterization rate was significantly higher in Group B than in both Group C and Group A (17.9%,0.0% vs. 4.3%, P = 0.026). Our findings suggest that for patients with complete pleural adhesions undergoing video-assisted thoracoscopic lobectomy, the combined application of a 28 F silicone tube and an 8 F pigtail catheter may demonstrate potential advantages in optimizing the balance between effective drainage and patient comfort, as well as in promoting postoperative recovery. This method warrants further validation in prospective studies.