Open Thoracotomy and Decortication for Chronic Empyema

Abstract

Andrade-Alegre R, Garisto JD, Zebede S. Open thoracotomy and decortication for chronic Empyema. Clinics. 2008;63:789-93. OBJECTIVES:Traditionally, chronic empyema has been treated by thoracotomy and decortication. Some recent reports have claimed similar clinical results for videothoracoscopy, but with less morbidity and mortality than open procedures. Our experience with thoracotomy and decortication is reviewed so that the results of this surgical procedure can be adequately evaluated. MATERIALS AND METHODS:From March 1992 to June 2006, 85 patients diagnosed with empyema were treated at Santo Tomás Hospital by the first author. Diagnosis of chronic empyema was based on the duration of signs and symptoms before definitive treatment and imaging findings, such as constriction of the lungs and the thoracic cage. Thirty-three patients fulfilled the criteria for chronic empyema and underwent open thoracotomy and decortication. RESULTS: Twenty-seven patients (81.8 %) were male and the average age of the study group was 34 years. The etiology was pneumonia in 26 patients (78.8%) and trauma in 7 (21.2%). The duration of symptoms and signs before definitive treatment averaged 37 days. All patients had chronic empyema, as confirmed by imaging studies and operative findings. Surgery lasted an average of 139 min. There were 3 (9%) complications with no mortality. The post-operative length of stay averaged 10 days. There were no recurrences of empyema. CONCLUSIONS: Open thoracotomy and decortication can be achieved with low morbidity and mortality. Long-term functional results are especially promising. We suggest that the validation of other surgical approaches should be based on comparative, prospective and controlled studies.

Surgical and Medical Treatments of Empyema in Pediatric Patients

“…In the present work, both surgically and medically treated patients had no short or long-term complications; but, duration of hospital stay and ICU admission time were significantly longer in surgically treated patients compared with medically treated ones. Our results showed fewer hospital stay days and similar morbidity and mortality rates in medically treated patients compared with patients treated surgically, similar to other studies (8). However, some authors believed that decortication was a highly effective treatment for chronic parapneumonic empyema, may be performed with low morbidity and mortality, and patients can spent less time in hospital (9).…”

Pleurectomy Decortication in the Treatment of the “Trapped Lung” in Benign and Malignant Pleural Effusions

“…The outcomes of surgical decortication are dependent on the duration of preoperative treatments, comorbidities, and preoperative duration of symptomspredicted morbidity. 26,27 Surgical decortication is associated with varied morbidity and mortality given the coexisting sepsis and comorbidities. Decortication is more frequently necessary for anaerobic, tuberculous, staphylococcal, and pneumococcal infections.…”

Traumatic thoracobiliary (pleurobiliary and bronchobiliary) fistula

“…Furthermore, it determines the existence of a pleural cortex which would indicate the need for decortication. 12 A hepatobiliary iminodiacetic acid scan has also been used for the diagnosis of TBF. However, it appears to fall short of localizing and defining the extent of the lesion, unless it is a large fistula.…”