Thoracoscopic decortication: a role for video-assisted surgery in chronic postpneumonic pleural empyema

doi:10.1016/S0003-4975(01)02471-7

The Annals of Thoracic Surgery

Volume 71, Issue 6, June 2001, Pages 1813-1816

https://doi.org/10.1016/S0003-4975(01)02471-7 Get rights and content

Abstract

Background. We evaluated a technique of video-assisted thoracoscopic (VAT) decortication of the visceral cortex to reexpand entrapped lung in cases of chronic postpneumonic pleural empyema.

Methods. A prospective cohort study of 48 consecutive patients with multiloculated postpneumonic pleural empyema in whom visceral pleural decortication was required was studied. The effect of VAT decortication on perioperative outcome and factors affecting its success were assessed.

Results. Before the introduction of VAT decortication 12 patients were treated by thoracotomy (group T). In the subsequent 36 patients VAT decortication was attempted with success in 21 (group VS) but lung expansion was not observed in 15 patients (group VF) who required thoracotomy. There was no difference in the age or sex distribution of the 3 groups. Operating time was significantly longer in group T than group VS, mean difference 30.3 minutes (p = 0.001) and postoperative hospital stay was longer in group T than group VS, mean difference 2.9 days (p = 0.004). The success of VAT decortication was not related to either the delay between onset of symptoms or hospital admission and surgery; indeed the operating time decreased with increasing preoperative delay. However, success was related to increasing operative experience (p = 0.001).

Conclusions. VAT decortication is a feasible new technique to achieve lung reexpansion in chronic postpneumonic pleural empyema and has perioperative benefits over thoracotomy.

Section snippets

Patient selection

All patients referred to our thoracic surgical unit over a 3-year period with a multiloculated pleural empyema were considered for VATS. All patients had undergone chest radiography and either thoracic ultrasonography or computed tomography (CT) to confirm loculation. Evidence of pleural thickening was not a contraindication to VATS nor was prior intrapleural fibrinolysis. VATS was attempted irrespective of the etiology or chronicity of the empyema.

Surgical method

Double-lumen endotracheal intubation and

Results

We analyzed the records of 12 consecutive patients (group T) requiring open decortication of postpneumonic pleural empyema before the introduction of VAT decortication. In a subsequent series of 36 consecutive patients VAT decortication was attempted. The operation was successful in 21 of these patients (group VS) whereas the remaining 15 patients (group VF) required conversion to thoracotomy to achieve lung reexpansion after failed VAT decortication. All operations were performed by the

Comment

Video-assisted thoracoscopic decortication is a feasible treatment of chronic pleural empyema when pleural debridement alone is insufficient. Using conventional instruments it is a safe, effective, and durable method of achieving reexpansion of the trapped underlying lung by removing the visceral cortex in the same way as in open surgery. Since our first successful operation we have now adopted a policy of attempted VAT decortication in all cases of pleural empyema irrespective of chronicity.

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Original article: general thoracicThoracoscopic decortication: a role for video-assisted surgery in chronic postpneumonic pleural empyema

Abstract

Section snippets

Patient selection

Surgical method

Results

Comment

Chest

Ann Thorac Surg

Chest

J Thorac Cardiovasc Surg

Ann Thorac Surg

Videothoracoscopy in the treatment of early empyema; an initial experience

Ann R Coll Surg Engl

Original article: general thoracic
Thoracoscopic decortication: a role for video-assisted surgery in chronic postpneumonic pleural empyema