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Early thoracoscopic debridement and drainage as definite treatment for pleural empyema
1Department of General, Thoracic and Vascular Surgery, Nordwest-Krankenhaus Sanderbusch, Sande, Germany.
Objective:
To report our experience with early thoracoscopic debridement and drainage in the treatment of pleural empyema in the fibrinopurulent or early organising phase.
Design:
Prospective open study.
Setting:
District hospital, Germany.
Subjects:
10 Patients operated on between August 1991 and April 1993.
Interventions:
Double lumen intubation, followed by thoracoscopic opening of the empyema, evacuation of all pus under vision, debridement of the lung, irrigation of the thoracic cavity and insertion of a chest drain.
Main Outcome Measures:
Morbidity and mortality.
Results:
Cultures taken during the operation grew no pathogens in five cases; Streptococcus pneumoniae, and haemolytic streptococci (once in combination with Staphylococcus aureus), were cultured in two cases each; and Mycobacterium tuberculosis in one. Chest drains were removed a mean of 8.5 days after operation. All patients were well without signs of infection 1-21 months later, and in no case was conversion to open operation necessary.
Conclusion:
Early thoracoscopic debridement and drainage is a safe and effective alternative to open treatment of patients with pleural empyema in the fibrinopurulent or early organising phase.