Optimizing biomaterials and surgical strategies for prevention and treatment of persistent air leak after thoracoscopic pulmonary resection: a practice review based on risk stratification

Over 2 million thoracoscopic pulmonary resections are performed globally each year, however, postoperative persistent air leak (PAL) remains a common and challenging complication. It not only prolongs hospital stays and increases treatment costs but may also lead to severe complications, particularly inducing a higher risk in patients undergoing mechanical ventilation. In recent years, with the improvement of preoperative preventive measures, the advancement of surgical techniques, and the application of repair materials, the incidence of PAL has decreased. This review systematically summarized the definition, clinical impact, risk factors and preventive strategies of PAL, and explored commonly used treatment modalities, such as thoracic drain management, pleurodesis and the application of novel repair materials. It also analyzed the effectiveness, safety and challenges of existing techniques. Furthermore, this review proposed the establishment of an enhanced recovery after surgery (ERAS) integrated pathway combining bovine pericardium (BP) patch with electro-mechanical stapler and conducted corresponding treatment benefit-cost assessment.