Clagett open-window thoracostomy in patients with empyema who had and had not undergone pneumonectomy.
Patients with empyema not responding to simple chest-tube drainage and antibiotic therapy have been managed by a "Clagett"-type procedure that consists of open-window thoracostomy, antibiotic irrigation and closure of the window. The results of such treatment were reviewed. Of the 103 patients with empyema treated between 1967 and 1983, 41 underwent open-window thoracostomy. Twenty-eight (group 1) had empyema after pneumonectomy, 13 (group 2) did not; however, 9 of the 13 in group 2 had undergone lobectomy. The mean follow-up was 46 months for group 1 and 42 months for group 2. When surgical closure of the open-window thoracostomy was attempted, the success rate in group 1 was 85% for those without concomitant bronchopleural fistula, but only 36% in patients with a fistula. In group 2 the respective success rates were 50% and 57%. Unsuccessful closure resulted in chronic fistulas in four patients in each of the two groups. Six deaths in group 1 and two in group 2 were related to the original disease, but one was an operative death. These results demonstrate both the effectiveness and limitations of open-window thoracostomy in the management of these difficult cases.
Bayes
A J
AJ
Department of Surgery, Montreal Chest Hospital Center, PQ.
Wilson
J A
JA
Chiu
R C
RC
Errett
L E
LE
Hedderich
G
G
Munro
D D
DD
D000368:Aged; D001983:Bronchial Fistula / Q000601:surgery; D004653:Empyema / Q000209:etiology / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000209:etiology / Q000601:surgery; D011013:Pneumonectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D013907:Thoracostomy / Q000379:methods*