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Post-pneumonectomy empyema

P S Wong1, P Goldstraw

  • 1Dept. of Thoracic Surgery, Royal Brompton National Heart and Lung Hospital, London, UK.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 1, 1994
PubMed
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Managing post-pneumonectomy empyema (PPE) requires individualized treatment. Initial drainage is key, with further management depending on patient condition and the presence of bronchopleural fistulas (BPF).

Area of Science:

  • Thoracic Surgery
  • Pulmonary Medicine
  • Infectious Diseases

Background:

  • Post-pneumonectomy empyema (PPE) is a serious complication significantly increasing mortality after major thoracic surgery.
  • Management strategies for PPE are not standardized and must consider patient factors and the presence of bronchopleural fistulas (BPF).

Purpose of the Study:

  • To present the experience of managing 41 cases of post-pneumonectomy empyema.
  • To evaluate treatment outcomes for both simple PPE (without BPF) and complex PPE (with BPF).

Main Methods:

  • Initial management involved drainage in all 41 patients.
  • Simple PPE cases (n=23) were treated with rib resection and open drainage, with some later managed by Portovac drainage.
  • Complex PPE cases (n=18) with fistulas received individualized treatment, often involving further major surgery.

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Main Results:

  • Open drainage was the initial step for all patients; some progressed to successful Portovac drainage or Schede thoracoplasty.
  • For simple PPE, irrigation and closure after open drainage were successful in 8 out of 13 re-admitted patients.
  • Complex PPE management was individualized, with some small BPFs closing with drainage and Portovac obliteration.

Conclusions:

  • There is no single best treatment for post-pneumonectomy empyema; management must be tailored to individual patient circumstances.
  • Drainage is essential, with subsequent treatment options including open drainage, Portovac, thoracoplasty, and surgical closure.
  • Complex cases involving bronchopleural fistulas often necessitate aggressive and individualized surgical interventions.