Surgical strategy of complex empyema thoracis

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Pulmonary Medicine

Background:

• The optimal treatment for empyema thoracis remains a subject of debate among surgical approaches.
• Various methods, including pleural drainage, fibrinolytic therapy, VATS debridement, and open thoracotomy, are advocated for treating empyema thoracis.

Purpose of the Study:

• To compare the outcomes of open thoracotomy and video-assisted thoracoscopic surgery (VATS) for complex empyema thoracis.
• To evaluate the efficacy of VATS as an alternative to traditional open thoracotomy.

Main Methods:

• A retrospective study of 30 patients with complex empyema thoracis treated between 1994 and 1997.
• Procedures included 14 open thoracotomies and 16 VATS drainage/decortications.
• Etiologies included infectious, neoplastic, traumatic, and other causes.

Main Results:

• VATS procedures had a significantly shorter duration of postoperative chest tube drainage (4.7 days vs. 8.3 days for thoracotomy, p=0.01).
• VATS also demonstrated shorter operative times (76.2 min vs. 125.0 min) and less blood loss (131.6 ml vs. 313.9 ml).
• Hospital stay and morbidity were comparable, with three patients requiring prolonged ventilation and two VATS procedures needing conversion to open thoracotomy.

Conclusions:

• VATS is an evolving and attractive surgical approach for complex empyema thoracis.
• The reduced need for chest tube drainage with VATS, in the absence of comorbidities, supports its use as an alternative to thoracotomy.