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Open window thoracostomy for pleural empyema complicating partial lung resection
Fabio Massera1, Mario Robustellini, Claudio Della Pona
1Division of General Thoracic Surgery, E Morelli Regional Hospital, Sondalo, Italy.
The Annals of Thoracic Surgery
|February 24, 2009
Summary
Open-window thoracostomy (OWT) is effective for managing pleural empyema after partial lung resection, especially when performed promptly. Immediate OWT and smaller pleural cavities improve healing outcomes in these complex cases.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Infectious Disease
Background:
- Open-window thoracostomy (OWT) is standard for postpneumonectomy empyema.
- Controversies exist regarding OWT for empyema after less extensive lung resections.
Purpose of the Study:
- To evaluate the efficacy of OWT in managing pleural empyema complicating partial lung resections.
- To identify predictors of successful empyema healing in this patient population.
Main Methods:
- Retrospective analysis of 19 patients with pleural empyema after partial lung resection (1993-2003).
- Patients underwent OWT, with some receiving pleural obliteration or muscle transposition.
- Analysis of factors influencing empyema healing, including OWT timing and pleural cavity size.
Main Results:
- OWT achieved infection control in 10% of patients; 56% underwent successful OWT closure via obliteration or transposition.
- OWT closure was successful in all 5 patients with bronchopleural fistula.
- Immediate OWT (p < 0.001) and previous left pulmonary resections (p < 0.05) were significant predictors of healing.
Conclusions:
- Immediate OWT is a key predictor of empyema healing following partial lung resection.
- Smaller pleural cavities correlate with a higher likelihood of healing.
- Prolonged chest tube drainage was ineffective for late-onset empyema in entrapped lungs.
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