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[Video thoracoscopic treatment in pleural empyema]
L Solaini1, F Prusciano, F Di Francesco
1Unità Operativa di Chirurgia Generale Modulo di Chirurgia Toracica, Dipartimento di Chirurgia, Ospedale S. Maria delle Croci, Ravenna. isolaini@libero.it
Background:
To evaluate the possible role and the effectiveness of videothoracoscopy (VATS) in the treatment of pleural empyema.
Methods:
Personal experience on 40 cases of pleural empyema treated by (VATS) during 5 years is reported. The underlying diseases were: pneumonia (32), pneumothorax (3), tuberculosis (2), abdominal diseases (2) and lung cancer (1). Before VATS at least one thoracentesis was performed to evaluate the characteristic of the pleural fluid.
Results:
Due to complications related to thick pleural adhesions, in one case (2.5%) the procedure was converted to open surgery, while in the remaining 39 cases VATS was able to achieve a complete cleaning of the pleural space with re-expansion of the pulmonary parenchyma. The improvement of the clinical symptoms were observed after a mean period of 3.5 days (range: 1-12 days). Chest tube was removed in a mean period of 4.8 days (range: 3-11 days); five patients had prolonged air leak from 6 to 10 days after surgery.
Conclusions:
In conclusion we are of the opinion that VATS has to be considered a very important mean for the treatment of pleural empyema; its use in the fibrinopurulent phase of the disease should give very good results, while in the following phase its indications are controversial.