[Omentoplasty in surgical management of postpulmonectomy pleural empyema]

A method of treating postpulmonectomy pleural empyema, practically implemented in this country for the first time, is described. Three patients are subjected to operation. Right pulmonectomy for lung cancer and chronic inflammatory process is done twice, and left pleuropulmonectomy for tuberculosis--once. Postpulmonectomy empyema persists in all three cases regardless of the adequate continuous suction drainage and intrapleural antiseptic management. Anaerobic and gram-negative flora is isolated. The size and location of the intrapleural cavity being cured are assayed by CT, thoracic ultrasonography and fistulography. In none of the patients is clinical and FBS evidence of bronchopleural fistula established. The operative procedure consists in resection of a 4 cm segment from the underlying rib in the drainage zone, and further cavity treatment under thorascopic control. Minor median laparotomy and skeletization of the greater omentum are performed preserving a major nutrient vessel depending on the location of the cavity. The omentum is drived into the pleural cavity through a parietal opening of the diaphragm, measuring 3-4 fingerbreadths. Pleural cavity drainage is carried out according to Redon. Two patients run an uneventful postoperative course. One female patient develops pylorospasm successfully cured by spasmolytic therapy and H2 blockers. CT and thoracic echography do not show presence of residual cavities. The patients are free of any complaints over periods ranging from 6 to 16 months postoperatively. The inference is reached that omentoplasty is a new method promoting successful elimination of both postpulmonectomy empyema, and other residual pleural cavities as well, with or without bronchopleural fistula.