Andrews thoracoplasty as a treatment of post-pneumonectomy empyema: experience in 23 cases

Icard, Philippe; Rochais, Jean Philippe Le; Rabut, Bertrand; Cazaban, S.; Martel, Bertrand; Evrard, C

doi:10.1016/s0003-4975(99)00699-2

Cited by 37 publications

(25 citation statements)

References 13 publications

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“…In selected cases it is a first-line procedure rather than being a last resort when every previous attempts failed [52] (3b). The 11% failure rate includes those who will carry on with permanent thoracostomy [55]. The overall mortality in these low case number series is about 4.3-5% [55,57,62].…”

Section: Thoracoplastymentioning

confidence: 94%

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Current surgical treatment of thoracic empyema in adults

Molnár¹

2007

European Journal of Cardio-Thoracic Surgery

208

182

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A review of the recent literature on treatment modalities of adult thoracic empyema was conducted in order to expose the controversies and verify where consensus exists. Critical reading filtered through clinical experience was the method followed. The roles of surgical drainage, lavage techniques, debridement via VATS, decortication, thoracoplasty and open window thoracostomy were considered using the Oxford Center of Evidence Based Medicine criteria. The roles of the different therapeutical modalities were interpreted in the light of the triphasic nature of empyema thoracis. The randomised controlled trials came up with conflicting results. With two exceptions all of the papers reviewed provide level (2b) or below evidences. The lack of a single ideal treatment modality or policy reflects the complexity of the diagnosis and staging of this heterogeneous disease. Basic elements of intervention--drainage, different evacuation techniques, decortication, thoracoplasty and open window thoracostomy--are well-established technical modalities; however, neither a universally acceptable primary modality nor the gold standard of their sequence is available. Drainage remains to be the initial treatment modality in Phase I disease. Debridement via VATS is a safe, reliable and efficient method in the fibrinopurulent phase. Organised pleural callus requires formal decortication. Open window thoracostomy is a simple and safe procedure for high-risk patients and results in quick detoxication. Thoracoplasty kept its final role in pleural space management. Acute postoperative bronchial stump insufficiency requires immediate surgery. Evacuation of toxic material is mandatory. No single-stage procedure offers a solution. An optimised agressivity treatment modality should be tailored to the condition of the patient and to the potential of the persisting cavity. Decision-making involves a triad consisting of the aetiology of empyema (i.e. primary vs secondary), general condition of the patient and stage of disease, while considering the triphasic nature of development of thoracic empyema. The current attitudes show that the present concepts are based mainly on expert opinion. Flexibility and patience on behalf of the surgeon and nursing staff, the patient and the hospital management, as well as a good understanding of the complexity of this condition are the cornerstones of the treatment. No exclusive sequence of procedures leading to a uniformly predictable successful outcome is available. Individualised approaches can be recommended based on institutional practice and local protocols. Thoracic empyema in general seems to remain resilient to fit completely into the categories of evidence-based medical approach.

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Section: Thoracoplastymentioning

confidence: 94%

“…Proper surgical technique and planning are needed to avoid deformities like scoliosis and other related consequences [54]. Unresponsive cases to less aggressive multiple treatments may obviate the need for thoracoplasty [52,55]. Thoracoplasty with or without myoplasty is a viable consolidating step in sequential empyema surgery.…”

Section: Thoracoplastymentioning

confidence: 99%

Current surgical treatment of thoracic empyema in adults

Molnár¹

2007

European Journal of Cardio-Thoracic Surgery

208

182

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“…Other authors have also recently published important series with quite similar results, with mortality, morbidity and hospitalization falling within an acceptable range of values. These data recommend the use of thoracomyoplasty procedures to solve difficult cases of intrathoracic suppurations (García-Yuste et al, 1998, Icard et al, 1999, Jadczuk 1998, Krassas et al, 2010, Regnard et al, 2000, Stefani et al, 2011.…”

Section: Personal Experience and Results From The Literaturementioning

confidence: 93%

“…Most surgeons use the Andrews thoracoplasty, with or without various modifications (Cornet et al, 1965, Icard et al, 1999. The technique was first described as a solution for postpneumonectomy empyema / thoracomediastinal plication (Andrews 1961) and then used for other types of empyema (Andrews 1965).…”

Section: Modern Thoracoplasty -The Andrews Procedures and It's Modificmentioning

confidence: 99%

Role of Thoracomyoplasty Procedures in Modern Surgery for Intrathoracic Suppurations

Botianu¹,

Botianu²

2012

Topics in Thoracic Surgery

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“…In cases where there is no improvement within less aggressive treatment procedures, toracomyoplasty may be the only option (34,35). This method may be a sovereign for the treatment of empires following pneumonectomy caused by bronchopular and / or esophagus -complicated fistula after pneumonectomy (36).…”

Section: Toracoplastymentioning

confidence: 99%