Thoracoscopic Debridement of Empyema Thoracis

doi:10.1016/S0003-4975(97)00917-X

The Annals of Thoracic Surgery

Volume 64, Issue 5, November 1997, Pages 1448-1450

https://doi.org/10.1016/S0003-4975(97)00917-X Get rights and content

Background

The primary treatment of empyema thoracis remains intercostal tube drainage together with antibiotics. Failure of primary treatment has until recently been an indication for thoracotomy and decortication. Video-assisted thoracoscopic debridement (VATD) has increased the available treatment options but requires validation.

Methods

A retrospective analysis was undertaken of 44 consecutive patients who presented for surgical treatment of empyema thoracis over a 3-year period.

Results

Two patients were unsuitable for VATD and were treated with open decortication (OD). Thirty patients were successfully treated by VATD. Two patients were converted to OD at the first operation, and 10 patients required OD as a second procedure. The mean duration of preoperative symptoms before referral was 37.6 ± 11.8 days (VATD) and 40.1 ± 11.6 days (OD) (p = not significant). The mean duration of hospitalization before transfer was 13.7 ± 2.4 days (VATD) and 11.5 ± 3.4 days (OD) (p = not significant). Intercostal drainage was required for 4.0 ± 0.3 days (VATD) and 8.5 ± 2.0 days (OD) (p = 0.004). The postoperative hospital stay was 5.3 ± 0.4 days (VATD) and 10.3 ± 2.1 days (OD) (p = 0.001).

Conclusions

Primary surgical therapy with VATD should be considered for all patients with pleural empyema, irrespective of the duration of symptoms. This approach does not preclude OD as a secondary procedure or conversion to OD after initial thoracoscopic assessment. The major advantages of VATD over OD are a shorter duration of postoperative intercostal drainage and reduced postoperative hospitalization.

Section snippets

Patients and Methods

From April 1993 to March 1996, 44 patients with empyema thoracis resistant to medical therapy were referred for surgical treatment. Patients were not excluded on the basis of the duration of symptoms before referral or the duration of their in-patient medical treatment. Two patients were considered unsuitable for a thoracoscopic operation because of a history of previous thoracic operations on the side of the empyema. The remaining 42 patients underwent VATD. All patients had a chest x-ray

Results

The mean patient age was 50.8 ± 3.7 years in the VATD group and 53.3 ± 6.2 years in the OD group (p = not significant). Twenty-one of the 30 VATD patients (70%) had either a chest drain inserted or had undergone needle aspiration of the collection before transfer. This was also the case for 8 of the 12 patients in the OD group (66.7%) (p = not significant). Similarly, 21 (70%) patients in the VATD group were receiving intravenous antibiotics at the time of transfer (p = not significant), versus 8

Comment

Empyema thoracis is common in people of all age groups. The natural history has been characterized by Barrett [10]. In the acute (exudative) and intermediate (fibrinopurulent) stages, the lung retains its compliance and has the capacity to fully expand if the fibrin layer on its surface is removed and the pleural space evacuated. At 4 to 6 weeks after the development of the empyema, however, this fibrin layer becomes organized and forms a thick peel (chronic or organizing phase). At this stage

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There are more references available in the full text version of this article.

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Thoracoscopic Debridement of Empyema Thoracis

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Comment

Am J Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Chest

Acute postpneumonic empyema treated by intercostal tube drainage with suction and pleural washing but without rib resection

Management of parapneumonic effusions: an analysis of physician practice patterns

Arch Surg