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Simple technique using a Lap-Protector for fenestration to manage empyema.

Noriyuki Matsutani1, Masafumi Kawamura

  • 1Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan, matsutani1970@yahoo.co.jp.

Surgery Today
|May 21, 2013
PubMed
Summary

A novel bedside fenestration technique using a Lap-Protector offers a less painful and more effective treatment for empyema in high-risk patients. This method avoids rib resection and simplifies wound care, improving outcomes for compromised individuals.

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Area of Science:

  • Thoracic Surgery
  • Infectious Diseases
  • Medical Device Innovation

Background:

  • Empyema management in compromised patients presents significant challenges.
  • High counts of multi-drug resistant bacteria, deteriorating health, and bronchial fistulas complicate traditional fenestration.
  • Existing fenestration methods may involve rib resection, leading to increased patient discomfort and complications.

Purpose of the Study:

  • To describe a novel, minimally invasive bedside fenestration technique for empyema.
  • To evaluate the efficacy and patient comfort of fenestration using a Lap-Protector compared to conventional methods.
  • To provide a safer and more convenient surgical option for high-risk empyema patients.

Main Methods:

  • A bedside fenestration procedure was performed under local anesthesia.
  • An incision was made in the thoracic wall using electric cautery.
  • A Lap-Protector was inserted to create the fenestration by widening the intercostal space, avoiding rib resection.

Main Results:

  • The Lap-Protector technique successfully managed empyema in high-risk patients.
  • This method is comparable to conventional rib resection fenestration but causes significantly less incisional pain.
  • Gauze changes are less painful as the wound is not in direct contact with the fenestration.

Conclusions:

  • Fenestration using a Lap-Protector is a convenient and effective alternative to conventional rib resection for empyema.
  • This technique offers improved pain management and ease of care for poor-risk patients.
  • The Lap-Protector facilitates successful bedside management of complex empyema cases.