title: Thoracoscopic management of postpneumonectomy empyema.
abstract: BACKGROUND
  Even when there is no associated bronchopleural fistula, empyema is a serious complication of pneumonectomy. Aggressive surgical treatments are usually applied. However, a minimally invasive approach might achieve satisfactory results in selected patients.
  
  
  METHODS
  Out of 17 patients presenting with a postpneumonectomy empyema (PPE), 11 had a thoracoscopic approach. There were 9 males and 2 females, (age, 38-74; mean, 59 years). Ten patients had no proven bronchopleural fistula (BPF). One of them had a minor (< 3 mm) BPF. Empyema was confirmed by thoracentesis and bacteriological examination. All patients had immediate chest tube drainage and underwent emergency thoracoscopic debridement of the empyema. No irrigation was used postoperatively.
  
  
  RESULTS
  There was no mortality and no morbidity related to the procedure. The average duration of thoracoscopic debridement was 62 minutes (range: 45-80 minutes). In 8 patients the chest tube was removed between the fifth and thirteenth postoperative day (average, 8.6 days). They were discharged between the 9th and 24th postoperative day. In 3 patients, clinical and/or biological signs of infection persisted and reoperation was decided at day 5, day 10, and day 11. All 3 patients underwent open-window thoracostomy. The average follow-up of the 8 patients who underwent only thoracoscopy was 10 months (range, 2-27 months). None had recurrent empyema. The patient who presented with a minor BPF remained asymptomatic and is doing well after a 27 month follow-up.
  
  
  CONCLUSIONS
  Thoracoscopy might be a valuable approach for patients presenting with PPE with or without minor bronchopleural fistula.
authors.affiliation: Thoracic Department, Institut Mutualiste Montsouris, Paris, France. dominique.gossot@imm.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Gossot
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Stern
authors.forename: Domenico
authors.initials: D
authors.lastname: Galetta
authors.forename: Denis
authors.initials: D
authors.lastname: Debrosse
authors.forename: Philippe
authors.initials: P
authors.lastname: Girard
authors.forename: Raffaele
authors.initials: R
authors.lastname: Caliandro
authors.forename: Luke
authors.initials: L
authors.lastname: Harper
authors.forename: Dominique
authors.initials: D
authors.lastname: Grunenwald
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D001983:Bronchial Fistula / Q000150:complications / Q000601:surgery; D002177:Candidiasis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D003131:Combined Modality Therapy; D003646:Debridement; D016724:Empyema, Pleural / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010995:Pleural Diseases / Q000150:complications / Q000601:surgery; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D013396:Suction; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D007507:Therapeutic Irrigation; D020775:Thoracic Surgery, Video-Assisted; D013907:Thoracostomy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents