Objective: To report our experience with early thoracoscopic debridement and drainage in the treatment of pleural empyema in the fibrinopurulent or early organising phase.
Design: Prospective open study.
Setting: District hospital, Germany.
Subjects: 10 Patients operated on between August 1991 and April 1993.
Interventions: Double lumen intubation, followed by thoracoscopic opening of the empyema, evacuation of all pus under vision, debridement of the lung, irrigation of the thoracic cavity and insertion of a chest drain.
Main outcome measures: Morbidity and mortality.
Results: Cultures taken during the operation grew no pathogens in five cases; Streptococcus pneumoniae, and haemolytic streptococci (once in combination with Staphylococcus aureus), were cultured in two cases each; and Mycobacterium tuberculosis in one. Chest drains were removed a mean of 8.5 days after operation. All patients were well without signs of infection 1-21 months later, and in no case was conversion to open operation necessary.
Conclusion: Early thoracoscopic debridement and drainage is a safe and effective alternative to open treatment of patients with pleural empyema in the fibrinopurulent or early organising phase.