Surgical Treatment of Pleural Empyema – Our Results

Abstract

Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity, mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need to use extensive surgery -decortications or thoracoplasty. Early recognition of the parapneumonic effusion and the adequate treatment with thoracentesis or pleural drainage, which is minimally invasive, is possible not to prograde the process and not to become empyema. aim: To analyze the results of the surgical treatment in patients with empyema treated at Clinic for thoracic surgery. Material and methods:In the retrospective study we analyzed 234 patients with empyema which were treated at the Clinic for Thoracic Surgery in 5 year period (2011)(2012)(2013)(2014)(2015). The mean age of the patients was 51.94 years. They were treated with pleural drainage, decortications or thoracoplasty. results: With pleural drainage were treated 165/234 (70.51%) patients, of which successfully were finished 124/165 (75.15%), but 41/165 (24.85%) were indicated after the decortications. A total of 108/234 (46.15%) were treated with decortications from which, primary decortications were indicated in 67/234 (28.63%) patients. 5/234 (2.14%) patients were treated with thoracoplasty -3 of the patients with decortications and 2 with primary indicated thoracoplasty according to the local findings, long term untreated empyema and bad general condition. The Mean hospitalization was 17.4 days, of which 13.4 days after surgery. In the group with primary drainage it was detected a lethal outcome in 7/124 (5.64%) patients, 5/105 (4.76%) in the group with decortications and 2/5 (40%) in the group with thoracoplasty. conclusion: Early detection of the parapneumonic effusion and the adequate treatment will prevent the appearance of empyema. If the empyema is detected it is necessary as early as possible to start the treatment with minimally invasive pleural drainage. In earlier stages it is possible to use less invasive decortications, using VATS than the open thoracotomy decortication which is more extensive surgical intervention.

Tracheo‐esophageal fistula and pleural empyema in the course of SARS‐CoV‐2 infection—A case report

“… 20 VATS is an alternative to thoracotomy, which is a more extensive surgical procedure in the early stages of an empyema. 21 In the patient described above, the pleural empyema was very extensive, therefore, the decision was made to treat with classic thoracotomy.…”

“…Regarding the surgical approach, video‐assisted thoracic surgery (VATS) is considered the “gold standard for the surgical management of an empyema.” 19 VATS enables the proper decortication of an empyema as effectively as thoracotomy, and is associated with less pain and, at the same time, greater patient acceptance 20 . VATS is an alternative to thoracotomy, which is a more extensive surgical procedure in the early stages of an empyema 21 . In the patient described above, the pleural empyema was very extensive, therefore, the decision was made to treat with classic thoracotomy.…”

“…20 VATS is an alternative to thoracotomy, which is a more extensive surgical procedure in the early stages of an empyema. 21 In the patient described above, the pleural empyema was very extensive, therefore, the decision was made to treat with classic thoracotomy. Yarlagadda et al described the effective use of the VATS technique in the treatment of a pleural empyema in the course of SARS-CoV-2 infection.…”

Impact of photon counting detector CT derived virtual monoenergetic images and iodine maps on the diagnosis of pleural empyema

“…Even though there are optimized managing guidelines, the morbidity and mortality is still significant [4]. To prevent an extensive thoracic surgery like thoracotomy decortication which goes in hand with a high mortality, a promptly detection and distinction of this pathology from non-infectious pleural effusion is crucial [5].…”