Decortication is a valuable option for late empyema after collapse therapy

Area of Science:

• Thoracic surgery
• Pulmonary medicine
• Infectious disease

Background:

• Infections in prior collapse therapy spaces present significant clinical challenges.
• Artificial pneumothorax for tuberculosis historically led to complications like empyema.
• Evaluating conservative surgical options is crucial for patient outcomes.

Purpose of the Study:

• To assess the efficacy and safety of decortication as a primary surgical treatment.
• To compare decortication outcomes with other surgical interventions for post-collapse therapy space infections.
• To identify factors influencing treatment success and complications.

Main Methods:

• Retrospective analysis of 28 patients treated since 1979 for empyema after artificial pneumothorax.
• Surgical interventions included decortication (n=24), thoracoplasty (n=2), and extrapleural pneumonectomy (n=2).
• Patient data included age, time since pneumothorax, vital capacity, and microbiological findings.

Main Results:

• Decortication demonstrated nil operative mortality, contrasting with one death after extrapleural pneumonectomy.
• Prolonged air leaks were common after decortication but ultimately resolved.
• Presence of symptoms was a significant predictor of prolonged air leaks (p < 0.01).

Conclusions:

• Decortication provides a viable one-stage surgical cure for empyema in post-collapse therapy spaces.
• This approach effectively avoids the high morbidity and mortality associated with extrapleural pneumonectomy.
• Decortication facilitates space resolution by the nonfunctioning lung, promoting healing.