Omentoplasty together with partial thoracoplasty: a one-stage operation for postpneumonectomy pleural empyema

Postpneumonectomy pleural empyema is a rare but life-threatening complication in thoracic surgery. This article describes our treatment strategy of this condition with omentoplasty plus partial thoracoplasty.

During a 2-year period 5, patients were treated. Three patients had clinical signs of bronchial stump fistula confirmed by bronchoscopy and during thoracotomy. Four patients were preoperatively treated with tube thoracostomy and pleural irrigation (median 21 days). In one case no preoperative drainage procedure was used. All patients were treated by partial thoracoplasty and omental transfer as a single-stage operation. Thoracoplasty was performed extrapleurally according to CT findings to reduce the volume of the empyema cavity. Subsequently, the empyema cavity was opened and cleaned. Upper midline incision was used to mobilize omentum majus and transfer it through the diaphragm into the thoracic cavity.

In 3 patients, the omentum filled the cavity only partially but that did not influence the results. All patients recovered without major complications. Two patients had nausea during the first postoperative days. No recurrence of pleural empyema occurred. Omentoplasty together with partial thoracoplasty is a safe and effective method in the treatment of postpneumonectomy pleural empyema both with and without broncial stump fistula. It can be performed as a single-stage operation without a pre- or postoperative open-window thoracostomy.