Utility of Single Transhiatal Chest Drainage After Minimally Invasive Esophagectomy: A Propensity-Score Matched Study of Safety and Feasibility.

Background: The routine placement of intercostal chest drains remains common practice following minimally invasive esophagectomy (MIO). Intercostal chest drains may contribute to increased postoperative pain and morbidity. This study compared outcomes between transhiatal and intercostal chest drain placement following MIO, focusing on analgesia use, hospital length of stay, and postoperative pulmonary complications.

Methods: This was a retrospective case-control study of patients undergoing elective MIO at a quaternary center in Western Australia between September 2016 and September 2023. Propensity score matching was used to minimize confounding. All patients were identified from a prospectively maintained database. Patients undergoing MIO with exclusive transhiatal drainage, a 19 French Blake's drain was advanced through the hiatus into the right pleural cavity and positioned adjacent to the anastomosis.

Results: Thirty patients were included in the study, 15 of whom had exclusively transhiatal drain placement. Mean total daily oral morphine dose equivalent was significantly lower in the transhiatal drain group (58 ± 35.8 mg) compared with the intercostal drain group (100.8 ± 64.0 mg) on postoperative Day 1 (p = 0.04). No significant difference was observed in the reintervention rate (p = 1.00), length of stay (p = 0.78), or postoperative pulmonary complications (p = 1.00).

Conclusion: Transhiatal drain placement following MIO was associated with reduced opioid requirements on postoperative Day 1 and demonstrated comparable pulmonary complications and length of stay to intercostal drainage. These findings suggest that transhiatal drainage may be a safe and feasible alternative; however, larger prospective studies are required to confirm these preliminary results.