[A study on selection of operative technique for chronic empyema based on findings obtained from reoperated cases]

In 13 patients undergone reoperation for chronic empyema during 9 years period from 1975 to 1983, the operative technique employed for the initial treatment, number of operations, findings of fistula and residual cavity and complications associated with each technique were reviewed with following results. Among these reoperated patients, the initial operation was thoracic cavity reduction in 5 cases, pulmonary detachment in 6 cases and air-plombage (Kinchu method) in 2 cases. Reoperation was carried out in a total of 27 times. There were 6 cases (46%) which were operated more than 3 times. These 6 cases included none of the cases which underwent air plombage. At the time of the first reoperation, fistula was observed in 11 out of 13 cases. At the final operation the residual cavity was accompanied with fistula in 7 cases and empyema in 5 cases. As the final operation, chest wall plombage chiefly by a modification of Grow's method combined with pedicle muscle plombage was employed. In cases indicated for more than two times of operations of thoracic cavity reduction, chest wall plombage was useful for reoperation. On the basis of these results, indication of each operation to improve results of surgical treatment of chronic empyema was discussed by taking into consideration advantages and complications of each operative technique.