[Current indications and results of pulmonary decortication for nontuberculous chronic empyema]

Pulmonary decortication for nontuberculous chronic empyema has become a rare operation, whose indications and results are now rarely analysed and discussed. The authors report a series of 40 consecutive decortications performed over a period of 15 years.

40 patients treated by pulmonary decortication over 15 years for nontuberculous chronic empyema secondary to pneumonia (27 cases; 2/3 of cases), post-traumatic haemothorax (5 cases), iatrogenic infection after pleural tap (5 cases) and septicaemia (3 cases). Chronic empyema had been present for an average of 6 months (1 to 60 months). Decortication was performed for drainage of persistent pleural suppuration in 22 cases and to release the encysted lung in 18 cases. Decortication, always comprising parietal pleural stripping and visceral decortication, lasted an average of 3 hours (2 to 8 hours), and was accompanied by mean bleeding of 1 litre (of 200 ml to 3.41).

27 patients (67%) had an uneventful postoperative course, with drainage for 6 days and a mean hospital stay of 13 days. 13 patients (33%) developed various complications, mainly re-expansion defects (10 cases), responsible for pyothorax in 4 cases, 3 of which required secondary drainage. One patient died from intestinal obstruction in a context of peritoneal carcinomatosis (operative mortality: 2.5%). 25 patients were reviewed with a mean follow-up of 54 months, with complete pulmonary re-expansion in 23 cases (92%) and a residual pouch in 2 cases. Vital capacity (VC) was evaluated in 8 patients, with a mean improvement of 40% (15 to 66%) in 6 patients, stable VC in one patient, and a 25% reduction in the last patient, a smoker and with chronic bronchitis.

Pulmonary decortication is an effective, but relatively major operation to treat chronic encysted empyema. Encystment must be prevented by effective drainage of empyema, now facilitated by the possibility of early videothoracoscopic pleural debridement.