[Video-assisted thoracoscopic access in pleural empyema compared with mere chest tube drainage]

Video-assisted thoracoscopic (VAT) debridement is gaining importance in the fibrino-purulent phase of empyema thoracis. However, evaluation of this access compared with mere chest tube drainage or thoracotomy remains unsatisfactory. A total of 356 parapneumonic empyemas from 1986 to 1997 were retrospectively analyzed concerning the results after primary treatment (chest tube 225, thoracotomy 80, VAT 51). The three groups did not differ significantly for gender and associated diseases. Median age of the chest tube drainage group (54 years) was higher than for thoracotomy (43.5 years) or VAT (39 years). Median duration of chest tube treatment after thoracotomy (7 days) was shorter than after VAT (13 days) or chest tube drainage (20 days) (P < 0.0001). The more invasive procedures were also superior to the lesser invasive treatment concerning duration of postoperative hospitalization, recurrence rate and treatment failures. In spite of its better results thoracotomy will be pushed back by VAT in the treatment of empyema thoracis. Acceptance of VAT is reflected in rising numbers of admissions. Based on these retrospective results we are planning a prospective multicenter trial to evaluate the indication for VAT in empyema thoracis.