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Pleural space irrigation and modified Clagett procedure for the treatment of early postpneumonectomy empyema
F Gharagozloo1, G Trachiotis, A Wolfe
1Department of Cardiovascular and Thoracic Surgery, Georgetown University Medical Center, and the National Cancer Institute, Washington, DC, USA.
Objective:
The incidence of postpneumonectomy empyema is 5% to 10%. Approximately half of postpneumonectomy empyemas occur within 4 weeks of pneumonectomy. A bronchopleural fistula is found in more than 80% of the patients. The classic treatment of postpneumonectomy empyema includes parenteral antibiotics, drainage of the pleural space, removal of necrotic tissue, and open pleural packing for many weeks followed by obliteration of the empyema space with antibiotic fluid or muscle. This approach results in prolonged hospitalization, repeated operations, and significant morbidity. As a possible means of decreasing morbidity with the classic treatment of postpneumonectomy empyema, we studied the use of pleural space irrigation in these patients.
Method:
In a 5-year period, we treated 22 patients with early postpneumonectomy empyema. All patients had a bronchopleural fistula. All patients underwent emergency drainage of the pleural space followed by thoracotomy, debridement of necrotic tissue, closure of the bronchial stump with absorbable monofilament suture, and pleural space irrigation. After a negative Gram stain from the pleural fluid, the pleural space was filled with 2 L of debridement antibiotic solution (DAB solution) (gentamicin 80 mg/L, neomycin 500 mg/L, and polymyxin B 100 mg/L), and the irrigation and drainage catheters were removed.
Results:
Twenty patients had negative Gram stains on day 9, and 2 patients had a negative Gram stain on day 16. The mean duration of hospitalization was 12.9 +/- 3. 4 days. There was no recurrence of empyema or a bronchopleural fistula.
Conclusions:
Pleural space irrigation followed by obliteration of the pleural space with an antibiotic solution required one surgical procedure and resulted in significantly shorter hospitalization and decreased morbidity in patients with early postpneumonectomy empyema.
Insights
Early postpneumonectomy empyema can be effectively treated with pleural space irrigation and antibiotic solution. This method requires one surgery, reduces hospitalization, and decreases patient morbidity.
Area of Science:
- Thoracic Surgery
- Surgical Infections
- Pulmonary Medicine
Background:
- Postpneumonectomy empyema affects 5-10% of patients, often presenting with bronchopleural fistula.
- Traditional treatment involves prolonged hospitalization, multiple surgeries, and significant morbidity.
- Early intervention is crucial for managing postpneumonectomy empyema.
Purpose of the Study:
- To evaluate the efficacy of pleural space irrigation as a treatment for early postpneumonectomy empyema.
- To assess the impact of this technique on hospitalization duration and patient morbidity.
- To determine if pleural space irrigation can reduce the need for repeated surgical interventions.
Main Methods:
- A cohort of 22 patients with early postpneumonectomy empyema and bronchopleural fistula were treated.
- All patients underwent emergency pleural drainage, thoracotomy, debridement, and bronchial stump closure.
- Pleural space irrigation with a debridement antibiotic solution was performed postoperatively.
Main Results:
- Twenty patients achieved negative Gram stains by day 9, with two by day 16.
- The average hospitalization duration was 12.9 days.
- No recurrence of empyema or bronchopleural fistula was observed.
Conclusions:
- Pleural space irrigation followed by antibiotic obliteration is a single-procedure treatment for early postpneumonectomy empyema.
- This approach significantly shortens hospitalization and reduces morbidity.
- The technique offers a less invasive alternative to traditional multi-stage treatments.
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