title: Video-assisted thoracoscopic surgery for thoracic empyema: primarily, or after fibrinolytic therapy failure?
abstract: BACKGROUND
  Traditional and modern treatments are proposed for thoracic empyema. The efficacy of video-assisted thocoscopic surgery (VATS) has been studied when the method is applied either as primary treatment for thoracic empyema or after the failure of fibrinolytic therapy.
  
  
  METHODS
  Thirty-eight patients treated with VATS for thoracic empyema have been reviewed. Of those, 20 patients (group 1) with empyema thoracis were referred to VATS after failure of the fibrinolytic treatment. Another 18 patients (group 2) with primary empyema thoracis were treated thoracoscopically immediately when empyema was diagnosed. Both groups were staged 5, 6, or 7 according to Light's criteria.
  
  
  RESULTS
  The group 2 patients showed a higher empyema resolving rate (95% versus 85%), shorter hospital stay (4.5 versus 7.5 days), and significantly shorter duration of the procedure (70 +/- 14 versus 62 +/- 10 minutes) in comparison with the patients of group 1.
  
  
  CONCLUSIONS
  The VATS technique for thoracic empyema is a well-tolerated, minimally invasive technique, with excellent therapeutic results, mild postoperative complications, and reduced hospitalization. VATS should be considered as the treatment of choice for thoracic empyema, in the fibrinopurulent stage, as it is more effective when applied primarily than when applied after fibrinolytic therapy.
authors.affiliation: Department of Thoracic Surgery, University General Hospital of Heraklion, University of Crete, GR-71110, Heraklion, Crete, Greece. petrakis@post.com
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Petrakis
authors.forename: Nektarios E
authors.initials: NE
authors.lastname: Kogerakis
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Drositis
authors.forename: Kostas G
authors.initials: KG
authors.lastname: Lasithiotakis
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Bouros
authors.forename: Georgios E
authors.initials: GE
authors.lastname: Chalkiadakis
mesh_terms: D000328:Adult; D000368:Aged; D016724:Empyema, Pleural / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D015912:Thrombolytic Therapy; D017211:Treatment Failure