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Decortication for chronic postpneumonic empyema

A T Martella1, G H Santos

  • 1Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.

Journal of the American College of Surgeons
|May 1, 1995
PubMed
Summary
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Decortication surgery effectively treats chronic postpneumonic empyema when antibiotics fail. This procedure can reveal complications missed by initial imaging, improving patient outcomes.

Area of Science:

  • Thoracic Surgery
  • Pulmonary Medicine
  • Infectious Diseases

Background:

  • Chronic postpneumonic empyema presents significant morbidity and mortality.
  • Empyemas often arise secondary to primary lung infections, persisting despite antibiotic therapy.
  • Chronic empyema (4-6 weeks) restricts hemithorax movement, necessitating intervention.

Purpose of the Study:

  • To evaluate the efficacy of decortication for chronic postpneumonic empyema.
  • To assess the role of decortication in managing treatment-resistant empyema.
  • To identify complications not detected by preoperative imaging.

Main Methods:

  • Retrospective analysis of 25 adult patients with chronic postpneumonic empyema undergoing decortication.
  • Inclusion criteria: failure of conservative antibiotic and tube drainage therapy.

Related Experiment Videos

  • Surgical procedures included decortication, with additional resections or debridements as needed.

    • Main Results:

    • Decortication was effective in controlling infection and releasing pulmonary entrapment.
    • 40% of patients required further surgery (pneumonectomy, lobectomy, wedge resection, abscess debridement).
    • Preoperative imaging (X-rays, CT scans) had limitations in predicting operative findings; 4% mortality and 4% recurrence rate observed.

    Conclusions:

    • Decortication is a highly effective treatment for chronic postpneumonic empyema.
    • The procedure can uncover underlying complications contributing to treatment failure.
    • Pulmonary abscess and necrosis may not be diagnosed preoperatively.