The Efficacy of VATS and Intrapleural Fibrinolytic Therapy in Parapneumonic Empyema Treatment

Abstract

Background: Development of multiloculation-septation is a challenging entity in empyema patients. In this study, it is aimed to investigate the success rates of videothoracoscopic deloculation (VATS-D) and intrapleural fibrinolytic (IPFib) application after tube thoracostomy. Methods: The study retrospectively examined the patients diagnosed with empyema with multiloculation and septation between January 2005 and December 2014. Among these patients, the study included those who received VATS-D or IPFib therapy. Results: VATS-D (Group 1) was applied to 54 patients and IPFib (Group 2) was applied to 24 patients. The success of both procedures was evaluated considering the need of decortication in the following periods. In the VATS-D group, 4 (7.4%) patients required decortication via thoracotomy where it was 1 (4.1%) patient (p = 0.577) in the IPFib group. The length of hospital stay was 6.81 ± 2.55 (4-15) days in Group 1 compared to 14.25 ± 6.44 (7-27) days in Group 2 (p <0.001). Conclusions: It was demonstrated that both of the methods applied in the study have high efficacy and are preferable methods based on the general conditions of patients. Additionally, the shorter length of hospital stays in patients received VATS-D was established as a significant parameter.

VATS and Intrapleural Fibrinolytic Therapy for Parapneumonic Empyema

“…With great interest, we read the article by Samancilar et al on the efficacy of video-assisted thoracoscopic (VATS) and intrapleural fibrinolytic (IPFib) therapy in parapneumonic empyema treatment (February issue, Ann Thorac Cardiovasc Surg, 2018). 1 ) We would like to ask four questions. First, the authors described the postoperative length of hospital stay.…”

“…First, the authors described the postoperative length of hospital stay. 1 ) However, there is no description of required condition to discharge hospital. We suppose that disappearance of drainage and removal of chest tube must be requited before the discharge of hospital.…”

“…However, one patient discharged with Heimlich valve. 1 ) Please let us know the condition and timing. Second, the authors reported that the total blood count and coagulation parameters of the patients were checked before every IPFib therapy.…”

“…Second, the authors reported that the total blood count and coagulation parameters of the patients were checked before every IPFib therapy. 1 ) Based on your experience, we would like to hear from the authors what are other tests than them to be done before performing of VATS deloculation (VATS-D) and IPFib? Is there a need to investigate the properties of pleural fluid by exploratory puncture?…”

“…Third, according to the authors, the introduction of fibrinolytic therapy could not be completed in six patients because of hemorrhagic drainage after third or fourth doses. 1 ) What kind of treatment was necessary for these patients? Fourth, one patient developed pleural thickening in the follow-up period with partial response to treatment and required decortication via thoracotomy.…”