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Empyema thoracis: a role for open thoracotomy and decortication
J A Carey1, J R Hamilton, D A Spencer
1Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
Archives of Disease in Childhood
|April 22, 1999
Summary
Open decortication surgery for advanced empyema (stages II and III) leads to rapid recovery and short hospital stays. This approach offers better outcomes than less invasive methods for complex cases.
Area of Science:
- Cardiothoracic Surgery
- Pediatric Surgery
- Infectious Diseases
Background:
- Stage I empyema typically resolves with thoracentesis and antibiotics.
- Management of advanced or late-presenting empyema remains controversial.
- Open thoracotomy and decortication is often perceived as leading to prolonged recovery.
Purpose of the Study:
- To challenge traditional views on open surgery for empyema.
- To evaluate the outcomes of open decortication in advanced empyema cases.
- To compare open decortication with other surgical strategies.
Main Methods:
- A five-year retrospective audit of pediatric empyema cases.
- Analysis of clinical course, surgical management, and patient outcomes.
- Inclusion of 22 children requiring surgical intervention.
Main Results:
- Eighteen children underwent open thoracotomy and decortication.
- Median duration of illness before referral was 15 days.
- Median hospital stay was 4 days, with rapid fever resolution and complete recovery.
Conclusions:
- Open decortication is effective for stage II and III empyema, ensuring rapid recovery and discharge.
- Early drain removal post-decortication contributes to swift symptomatic improvement.
- Alternative strategies may be considered for early-stage empyema, but open decortication offers superior outcomes in advanced disease.