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eComment: A tribute to Gotthard Bülau and Vincenzo Monaldi

Plastic, Hand and Reconstructive Surgery, Hannover Medical School, 30625 Hannover, Germany

Survey on chest drainage systems adopted in Europe

I read with great interest the recent European survey on chest drainage systems [1]. As this survey points out, there is no universal attitude towards the implementation, the use of chest drainage systems as well as for the optimal time to stop suction. Drainage is a matter of substantial debate in other surgical fields, too. As such, there is currently no clear evidence that using drains in patients undergoing thyroid operations significantly improves patient outcomes and drains may be associated with an increased length of hospital stay [2].

In routine uncomplicated laparoscopic cholecystectomy, drain use increases wound infection rates and delays hospital discharge. The authors could not find evidence to support the use of drain after laparoscopic cholecystectomy [3]. Thus, randomized-controlled trials are mandatory in thoracic as well as in cardiac surgery to elucidate the outcome regarding the use of a given chest tube.

In addition, this comment should tribute Dr. Bülau. Gotthard Bülau (1835–1900) introduced a closed water-seal drainage as early as 1875. Twentyseven years later, he published his findings in Zeitschrift für klinische Medizin [4]. He worked as consultant for internal medicine at the St. Georg Krankenhaus, Hamburg, Germany. Born on 27 February 1835 in Hamburg as the son of the physician Gustav Bülau, he studied medicine in Heidelberg and Göttingen from 1854 to 1858. Later he went to Hamburg to work in hospital, where he studied the use of his drainage.

Another pioneer should be cited as well. Vincenzo Monaldi (1899–1969), an Italian pulmologist, suggested the Monaldi approach at the 2nd or 3rd intercostal space in the medioclavicular line to drain a lung cavern. This was published in the German Münchener Medizinische Wochenschrift in 1950 [5]. A total number of 105 Medline-listed references can be retrieved from Dr. Monaldi from 1949 to 1969, which is remarkable.

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1. Mattioli S, Berrisford RG, Lugaresi ML, Aramini B. Survey of chest drainage systems adopted in Europe. Interact CardioVasc Thorac Surg 2008;7:1155–1159.[Abstract/Free Full Text]
2. Samraj K, Gurusamy KS. Wound drains following thyroid surgery. Cochrane Database Syst Rev 2007;4:CD006099.[Medline]
3. Gurusamy KS, Samraj K, Mullerat P, Davidson BR. Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev 2007;4:CD006004.[Medline]
4. Bülau G. Für die Heber-Drainage bei Behandlung des Empyems. Zeitschrift Klin Med 1891;380–392.
5. Monaldi V, De Marco F. Terminal technic of the suction drainage for pulmonary caverns. Munch Med Wochenschr 1950;92:823–826.[Medline]

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