Prevention of recurrent empyema after pneumonectomy for chronic infection.
OBJECTIVE
Pneumonectomy in chronic pulmonary infection with empyema is associated with a high mortality rate and an increased risk of recurrent empyema. The surgical resection is technically demanding, and successful management continues to be a challenge.


METHODS
We evaluated a concept which combines (pleuro-)pneumonectomy or completion pneumonectomy with surgical debridement of the pleural cavity and packing with povidine-iodine soaked dressings. The debridement and packing is repeated in the operating theater after 48 h until the chest cavity is macroscopically clean. Finally, the pleural space is obliterated with antibiotic solution.


RESULTS
Between February 1997 and October 2000, 11 patients (average age of 59 years, ranging from 25 to 84) with destroyed lung caused by tuberculosis (six), aspergilloma (two), bronchiectasis (one), esophago-pleural fistula (one) or broncho-pleural fistula after lobectomy for bronchial carcinoma (one) and ongoing chronic infection with acute empyema (ten) (25-2500 days between first and definitive therapy) were treated. Pleural culture findings showed Aspergillus in four, Mycobacterium in two, Enterococcus in two, Candida in one and Staphylococcus in one, respectively. The mean number of interventions was 2.9 (2-4). The chest was definitively closed in all patients within 1 week. The mean hospitalization time was 19 days (9-31 days). In the follow-up (10-54 months), there was no recurrence of empyema. One patient (84 years) died at day 31, due to sepsis.


CONCLUSIONS
Pneumonectomy combined with repeated surgical debridement and antimicrobial therapy enables the successful treatment of chronic pulmonary infection with empyema within a short time period.
Schneiter
Didier
D
Department of Surgery, Division of Thoracic Surgery, University Hospital, 8091 Zurich, Switzerland.
Kestenholz
Peter
P
Dutly
André
A
Korom
Stephan
S
Giger
Urs
U
Lardinois
Didier
D
Weder
Walter
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D016724:Empyema, Pleural / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011014:Pneumonia / Q000150:complications* / Q000601:surgery*; D012008:Recurrence; D013530:Surgical Wound Infection / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D016019:Survival Analysis; D013557:Switzerland; D017211:Treatment Failure