Original article: general thoracicThoracoscopic decortication: a role for video-assisted surgery in chronic postpneumonic pleural empyema
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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2017, Journal of Infection and ChemotherapyCitation Excerpt :Usage of anti-pseudomonal antibiotics as initial treatment is highly recommended if the patients are immunocompromised or have chronic pulmonary disease or when targeted pathogens are K. pneumonia spices or SPICE organisms. There are some evidences that delays in prompt and appropriate treatment subsequently result in more invasive interventions, leading to a more prolonged in-hospital recovery and poor outcomes [17,32,33]. In the present study, more CA empyema patients tended to receive surgical intervention than HCA empyema patients.