Chronic postpneumonic pleural empyema: comparative merits of thoracoscopic versus open decortication

Abstract

In the light of our experience, videothoracoscopic decortication appears to be the surgical treatment of choice for chronic postpneumonic pleural empyema even if a multicentric-randomised trial should be performed before videothoracoscopic decortication becomes the gold standard for the treatment of pleural empyema.

Outcomes of Video-Assisted Thoracic Surgical Decortication in 274 Patients with Tuberculous Empyema

“…Cardillo, et al compared the clinical outcomes of open thoracotomy decortication and decortication by VATS and demonstrated the latter to be better in terms of inpatient hospital stay, pain, postoperative air leak, operative time, and time to return to work. 5) Meanwhile, median operative times of 86, 90, and 75 min were obtained for VATS, thoracotomy, and minithoracotomy, respectively, with median total length of stay (LOS) of 15, 20.5 and 21 days, respectively; median preoperative LOS was longer for thoracotomy (10 days) compared with VATS (5 days) or mini-thoracotomy (1 day), while median postoperative LOS was longer for VATS (14 days) in comparison with thoracotomy (9.5 days) and mini-thoracotomy (8 days). 8) The LOS reported herein was 7.2 days, almost half of that of Karen, et al, though we observed longer operative time (104.5 ± 20.4 min).…”

“…3,4) As previously reported, decortication by VATS can be touted as the surgical treatment of choice for chronic post-pneumonic pleural empyema. 5) With decortication by VATS attracting increasing attention, it is imperative to assess its surgical outcomes through clinical studies with large sample size. Therefore, the present study aimed to explore the outcomes and complications associated with decortication by VATS, by retrospectively analyzing 274 patients with tuberculous empyema who underwent this procedure at a single Chinese center over a period of 10 years.…”

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

“…Prolonged air leak, bleeding, recurrence or persistence of the disease, surgical wound infection and residual pleural space are the most common complications. However, renal insufficiency, deep venous thrombosis, chylothorax, lesion of diaphragm, high response atrial fibrillation by some authors are also mentioned (5,6,8,9,11,18,20,22). In our series the complication rate was 19.7% (14 out of 71 patients): recurrence of disease (four patients), prolonged air leak (three), wound infection (three), hemothorax (three) and in-hospital death (one).…”

“…The complication rate after VATS empyemectomy varies from 9% to 40.2% (5,6,8,9,11,17,18,20,24,25,32). Prolonged air leak, bleeding, recurrence or persistence of the disease, surgical wound infection and residual pleural space are the most common complications.…”

“…The conversion rate in our study, according to the fact that we also included advanced (stage III) cases of empyema, was not very high -25.4%. Conversion to the thoracotomy is usually considered if there is impossible to enter the pleural cavity due to firm adhesions, completely dissect the peel from the underlying lung surfaces to achieve enough lung reexpansion or in cases of severe bleeding or significant air leak (12,(18)(19)(20)(21)23). The first two were the main reasons for conversion in our study.…”