Thoracoscopic management of postpneumonectomy empyema.
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.
Gossot
Dominique
D
Thoracic Department, Institut Mutualiste Montsouris, Paris, France. dominique.gossot@imm.fr
Stern
Jean-Baptiste
JB
Galetta
Domenico
D
Debrosse
Denis
D
Girard
Philippe
P
Caliandro
Raffaele
R
Harper
Luke
L
Grunenwald
Dominique
D
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
D000900:Anti-Bacterial Agents