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Updated: Jun 14, 2026
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Surgical treatment of pleural empyema according to disease stage
Ilijaz Pilav1, Safet Guska, Safet Musanovic
1Clinic of Thoracic Surgery, Clinical Center of Sarajevo University, Bosnia and Herzegovina.
Unlabelled:
Para pneumonic effusions are often complications of bacterial pneumonia, occurring in 5-50% patients and in 15% cases it can progress into pleural empyema. Pleural empyema treatment includes drainage of pus, re-expansion of lung by using appropriate antibiotics. Surgical treatment covers implementation of certain thoracic drainage modifications, use of VATS techniques and thoracotomy with pleura decortications.
Patients:
Research has involved 100 patients with diagnosis and treatment of para pneumonic and meta pneumonic pleural empyema.
Results:
Based on previously defined phase of pleural empyema it was determined which surgical procedures have been used in definitive treatment of pleural empyema. In case of 31,17% (24/77) patients it has been found that pre-clinical treatment lasted 31 days and longer, and 49,35% (38/77) patients have been admitted at Clinic after 11 to 30 days of pre-clinic treatment. Only in 19.48% (15/77) patients pre-clinic treatment lasted up to 10 days. 79% (79/100) patients were in third phase of disease, 19% (19/100) patients were in second phase and 2% (2/100) patients were in first stage of disease. Among patients with first stage of disease 1 patient was subject to pleural drainage and 1 was subject to decortications. Among patients with second phase of disease 10 patients were subject to pleural drainage and 9 to decortications. Among patients with third phase of disease 20 patients were subject to pleural drainage and 49 to decortications, 4 patients were subject to pleural drainage with rib resection, and 2 were subject to combination of thoracoscopy and drainage, while in case of 4 patients it was necessary to perform additional drainage.
Conclusions:
Pleural drainage is first procedure in surgical treatment of pleural empyema, but very often it is not definitive measure of treatment of patients with third phase of disease. Definitive treatment of empyema in third phase is decortications of pleura carried out on 62% patients with this phase of disease. Efficiency of treatment determined on basis of mortality level is satisfactory.
Insights
Para pneumonic effusions can progress to pleural empyema, requiring treatment such as pleural drainage and decortication. Decortication is often the definitive treatment for advanced pleural empyema.
Area of Science:
- Thoracic Surgery
- Pulmonology
- Infectious Diseases
Background:
- Para pneumonic effusions complicate bacterial pneumonia in 5-50% of patients.
- Pleural empyema, a progression of para pneumonic effusions, occurs in 15% of cases.
- Treatment involves antibiotics, lung re-expansion, and surgical interventions like drainage and decortication.
Purpose of the Study:
- To evaluate surgical procedures for treating para pneumonic and meta pneumonic pleural empyema.
- To determine the effectiveness of different surgical approaches based on disease phase.
Main Methods:
- Retrospective analysis of 100 patients diagnosed with pleural empyema.
- Categorization of patients based on disease phase (1st, 2nd, 3rd).
- Documentation of surgical interventions: pleural drainage, decortication, VATS, thoracotomy.
Main Results:
- Most patients (79%) presented in the third phase of the disease.
- Pleural drainage was the initial procedure for many, but decortication was definitive for 62% of third-phase patients.
- Delayed pre-clinical treatment (over 10 days) was common, affecting treatment outcomes.
Conclusions:
- Pleural drainage is an initial step, but decortication is crucial for definitive treatment in advanced pleural empyema.
- Surgical management, particularly decortication, shows satisfactory efficacy based on mortality rates.
- Timely intervention is critical for improving outcomes in patients with pleural empyema.
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