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Mini-thoracotomy for surgical treatment of adult parapneumonic empyema stage 2b-3 versus standard thoracotomy

Anna Chernihovsky, Michael Gelbstein, Andrey Zverev, Alexey Gavrilov, Edward Altman
European Respiratory Journal 2016 48: PA2526; DOI: 10.1183/13993003.congress-2016.PA2526
Anna Chernihovsky
1Radiology, Galilee Medical Center, Nahariya, Israel
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Michael Gelbstein
2Internal Medicine B, Galilee Medical Center, Nahariya, Israel
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Andrey Zverev
3Intensive Care Unit, Galilee Medical Center, Nahariya, Israel
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Alexey Gavrilov
3Intensive Care Unit, Galilee Medical Center, Nahariya, Israel
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Edward Altman
4Thoracic Surgery, Galilee Medical Center, Nahariya, Israel
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Abstract

Introduction: Parapneumonic empyema (PPE) is a difficult problem in modern medicine despite availability of antibiotics. Treatment with antibiotics, closed chest tube drainage and intrapleural fibrinolitics are recommended as first line treatment. Video-assisted thoracic surgery is effective in the early stages of PPE. Standard thoracotomy is used in PPE late stage 2b-3. Less invasive approach such as mini-thoracotomy is still has not well received for the late stage of PPE in adult patients.

Aim of the study: To evaluate the results of mini-thoracotomy for treatment of adult PPE in stages 2b-3 versus standard thoracotomy.

Methods: 57 adult patients with PPE in stages 2b-3 operated between 10/ 2001 and 10/ 2013 were selected. Demographic data, clinical manifestations, radiological appearance, histological characteristics of PPE, complications, length of stay in hospital, and early and late postoperative outcome were collected and analyzed.

Results: Of 57 patients 41 (71.9%) were male and 16 (28.1%) – female,

26 patients were in mini-thoracotomy group and 31 patients in standard thoracotomy group.

Physical restoration was quicker in mini-thoracotomy group and complete after one month. There was no difference in normalization of other clinical and laboratory parameters between the two groups.

Conclusions: Treatment of advanced PPE stage 2b-3 with mini-thoracotomy and standard thoracotomy was beneficial for both groups. Employment of mini-thoracotomy had the same efficacy as standard thoracotomy, but was characterized by quicker restoration of physical status due to less invasive approach.

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Mini-thoracotomy for surgical treatment of adult parapneumonic empyema stage 2b-3 versus standard thoracotomy
Anna Chernihovsky, Michael Gelbstein, Andrey Zverev, Alexey Gavrilov, Edward Altman
European Respiratory Journal Sep 2016, 48 (suppl 60) PA2526; DOI: 10.1183/13993003.congress-2016.PA2526

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Mini-thoracotomy for surgical treatment of adult parapneumonic empyema stage 2b-3 versus standard thoracotomy
Anna Chernihovsky, Michael Gelbstein, Andrey Zverev, Alexey Gavrilov, Edward Altman
European Respiratory Journal Sep 2016, 48 (suppl 60) PA2526; DOI: 10.1183/13993003.congress-2016.PA2526
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