Decision-making for lung resection in patients with empyema and collapsed lung due to tuberculosis

Olgac, Guven; Yılmaz, Muhammet Ali; Ortaköylü, Mediha Gönenç; Kutlu, Cemal Asım

doi:10.1016/j.jtcvs.2004.08.040

Cited by 23 publications

(21 citation statements)

References 8 publications

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“…The remaining ventilation/ perfusion mismatch is due to multilevel functional lung damage [47]. In patients with a longstanding posttuberculotic collapsed lung with minimal perfusion, decortication can be attempted but the outcome is unpredictable [48]. As far as the patient is symptomatic, the benefit of the procedure is proven (2b) [45][46][47][48][49].…”

Section: Decorticationmentioning

confidence: 99%

“…In patients with a longstanding posttuberculotic collapsed lung with minimal perfusion, decortication can be attempted but the outcome is unpredictable [48]. As far as the patient is symptomatic, the benefit of the procedure is proven (2b) [45][46][47][48][49]. However, decortication is not indicated and observation is warranted for asymptomatic patients [50].…”

Section: Decorticationmentioning

confidence: 99%

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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: Decorticationmentioning

confidence: 99%

Section: Decorticationmentioning

confidence: 99%

Current surgical treatment of thoracic empyema in adults

Molnár¹

2007

European Journal of Cardio-Thoracic Surgery

208

182

View full text Add to dashboard Cite

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“…The procedure was originally used for the treatment of tuberculous and posttraumatic empyema (29), and relies on the elasticity of the lung parenchyma that needs to fill the pleural space, leading to obliteration of the pleural space. In the event that the illness itself lasts for more than 6 weeks, which is equivalent to Phase III of the disease, recommendations are to apply decortication if the patient is capable of carrying out the operation (30).…”

Section: Decortication Of Pleuramentioning

confidence: 99%

“…In patients with long-standing post-tuberculous collapse of the lungs with minimal lung perfusion, decortication can be attempted, but the outcome is uncertain (29). In patients subjected to VATS for the treatment of empyema, conversion to open procedure (decortication) can occur in 3, 8 -40% (30,31).…”

Section: Decortication Of Pleuramentioning

confidence: 99%

Pleural Empyema Menagement: A Brief Review of Litterature

Arsenijević

Milisavljević

Mrvic

et al. 2018

Serbian Journal of Experimental and Clinical Research

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“…simple empyema secondary to parapneumonic effusions). In addition, VATS decortication has also successfully managed tuberculous empyema [31,32] and postpneumonectomy empyema [12,33 ].…”

Section: Video-assisted Thoracoscopic Surgerymentioning

confidence: 99%