Monaldi drainage

Dr. Aljobory Hazm - MD in thoracic medicine

Dr. Miron Iris - specialist in thoracic surgery

Has Alexandru - student at Medicine and Pharmacy University

The Monaldi drainage is a very old but useful surgical method used in  the thoracic surgery field, on pacients with tubercular and non tubercular lung abcess. Lung resection on these patients is not recommended due to the following reasons:

lesional: unilateral or bilateral expansion ot the lesion;
functional: poor ventilation combined with heart problems;
biological: patients with altered blood samples, decay of general health.

This method is very dangerous if not executed with precision and in certain lesional conditions, normaly:

it is compulsory that a pleuro-pulmonary adherence be created between the lesion (abcess) and the parietal pleura;
the lesion must not be located in the center, away from the thoracic wall (parietal pleura) because serious haemorrhage can occur, leading to exitus through hemoptysis;
generalized subcutaneous emphysema can also occur; this is very hard to contain.

Thenique

Usually, the lesion is located by imagistic guidance. This is the primary starting pointfor penetrating the outer layer of the lesion or healthy lung, causing the symptoms mentioned above.

The anesthesia and incision are done in the same way as in the case of  the pleurotoma (pleural drainage)

A transparietal trocar is introduced in the abcess cavity and,after that, a drainage tube is inserted.

Beside the drainage tube, we also introduced a thin catheter in the abcess cavity, for antibiotic administration.

The tube is fixed on the patient`s skin by conventional suture.

This method may allow an almost complete healing while otherwise it can be considered a preparation for the major surgery (pulmonary resection), after reevaluating the lesional, functional and biological reasons.