Nontuberculous Pleural Empyema in Adults

Symbas, Panagiotis N.; Nugent, Jeffrey T.; Abbott, Osier A.; Logan, William D.; Hatcher, Charles R.

doi:10.1016/s0003-4975(10)65095-3

Cited by 28 publications

(9 citation statements)

References 5 publications

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“…16 Panagiotis symbas, in 1971 modified Eloesser technique. 17 Clagett and Geraci, in1963, did technique of wide open rib resection and open drainage, and then they filled the cavity with antibiotic solution and closed the fistula.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Lateral Thoracotomy (MILT) and Decortication: A Prospective Study on Chronic Organised Empyema and its Outcome

Haridas¹,

Bhat²

2018

IJCMR

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Lateral Thoracotomy (MILT) and Decortication: A Prospective Study on Chronic Organised Empyema and its Outcome

Haridas¹,

Bhat²

2018

IJCMR

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“…After splitting the muscles of the thoracic wall and the ribs are exposed, segments of two or three adjacent ribs are transected. The U-shaped skin flap is fixed against the diaphragm, creating a epithelialized tract from the postpneumonectomy space to the outside (21,23). A crucial aspect to the creation of an Eloesser flap is selection of an optimal position to allow effective, passive drainage and relatively easy access for open wound packing and patient comfort (Figure 2).…”

Section: Open Thoracotomymentioning

confidence: 99%

Management of postpneumonectomy empyema and bronchopleural fistula

Azevedo¹,

Oliveira²,

Ugalde³

2021

Shanghai Chest

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Although the number of pneumonectomies performed worldwide is decreasing due to epidemiological changes in lung cancer, increased awareness of postoperative complications of pneumonectomy plays a major role in the proper clinical management and ultimately in the quality of life and survival rate of patients. Postpneumonectomy empyema is a rare but serious complication of pneumonectomy. The prognosis of postpneumonectomy empyema patients mainly depends on when the complication appears and the presence or absence of a bronchopleural fistula (BPF). The majority of empyema will occur within the first 3 months after surgery. The management of postpneumonectomy empyema is a challenge to thoracic surgeons due to the number of surgical approaches available and a lack of consensus as to the best approach. It can vary from a simple rib resection and open drainage to a complete thoracoplasty. Unfortunately, after pneumonectomy, patients who develop BPF and empyema will present prolonged hospitalization and are at risk of high morbidity and mortality rates. Consequently, successful therapy might be difficult to achieve, that is why is so important to well select your strategy. Though this remains an area of controversy in the field of thoracic surgery, accurate and expedited diagnosis is critical to achieve a cure. Regardless of the technique adopted for treatment, adequate pleural drainage, definitive closure of the BPF, sterilization of the pleural cavity, and obliteration of residual space are the key factors to favorable outcomes. In this article, the authors aim to discuss in detail the management strategy based on the clinical evolution of patients with postpneumonectomy empyema and BPF.

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“…The MEF is an inverted U-shaped cutaneous ap sutured inferiorly to the diaphragm below a segment of resected rib (Fig. 1D) 12 . In contrast to the traditional Clagett window and OWT, where the ultimate goal is chest closure after successful empyema treatment, EF and MEFs are historically closed primarily through epithelialization and obliteration of the empyema cavity over time with resolution of the empyema itself [11][12][13] .…”

Section: Surgical Interventions Include Video Assisted Thoracoscopic Surgery (Vats) Decortication and Open Thoracotomy With Decorticationmentioning

confidence: 99%

Short and Long-Term Outcomes of Surgical Intervention for Empyema in The Post-Fibrinolytic Era

Cain

Margolis

Lazar

et al. 2021

Preprint

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Background: Open window thoracostomy is indicated for patients with bronchopleural fistulae or trapped lung in the setting of empyema refractory to non-surgical interventions. We investigated the role of open window thoracostomy in the era of minimally invasive surgeries, endobronchial valves and fibrinolytic therapy.Methods: A retrospective chart review of all patients who underwent open window thoracostomy at a single institution from 2010-2020 was performed. Indications for the procedure as well as operative details and morbidity and mortality were evaluated to determine patient outcomes for open window thoracostomy.Results: Eighteen patients were identified for the study. The most common indication for open window thoracostomy was post-resectional bronchopleural fistula (n=8). Patient comorbidities were quantified with the Charleston Comorbidity index (n=11 score≥5, 10-year survival ≤21%). Three (16.7%) patients died <30 days post-operatively and 12 (66%) patients were deceased by the study’s end (overall survival 24.0 ± 32.2 months). Mean number of ribs resected were 2.6 ± 1.2 (range 1-6). Patients were managed with negative pressure wound therapy (n=9) or Kerlix packing (n=9). Eleven patients (61.6%) underwent delayed closure (mean time from index surgery to closure 4.8 ± 6.7 months). Conclusions: Our study illustrates the significant comorbidities of patients undergoing open window thoracostomy, the poor outcomes therein, and pitfalls associated with this procedure. We show that negative pressure wound therapy can be utilized as potential way to obliterate the pleural space and manage an open chest in the absence of an airleak; however open window thoracostomy procedures continue to be extremely morbid.

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Nontuberculous Pleural Empyema in Adults

Cited by 28 publications

References 5 publications

Minimally Invasive Lateral Thoracotomy (MILT) and Decortication: A Prospective Study on Chronic Organised Empyema and its Outcome

Minimally Invasive Lateral Thoracotomy (MILT) and Decortication: A Prospective Study on Chronic Organised Empyema and its Outcome

Management of postpneumonectomy empyema and bronchopleural fistula

Short and Long-Term Outcomes of Surgical Intervention for Empyema in The Post-Fibrinolytic Era

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