Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: outcome of 234 patients.
OBJECTIVE
To review our experience in treatment of complicated parapneumonic effusion and pleural empyema by video-assisted thoracoscopic surgery (VATS).


METHODS
Retrospective chart review.


METHODS
Taiwanese medical centers.


METHODS
A total of 234 patients (108 women, 126 men; median age, 51 years; range, 0.75 to 84 years) underwent procedures for parapneumonic effusion (145 patients) or pleural empyema (89 patients) between May 1995 and December 2003. All patients had chest radiographs, and 188 patients (80.3%) underwent preoperative CT or sonography. More than 85% (200 patients) received preoperative diagnostic or therapeutic thoracentesis, tube thoracostomy, or fibrinolytics. Indications for VATS included empyema refractory to medical control or peel or multiloculated exudates per CT and chest tapping.


METHODS
Septal lysis and debridement irrigation through one port (31 patients, 13.2%), decortication and debridement through two or three ports (179 patients, 76.5%), or rib resection or larger utility incision for decortication and drainage (24 patients, 10.3%).


RESULTS
Mean +/- SD procedural time was 64.3 +/- 22.5 min (range, 26 to 244 min). Sixteen patients (6.8%) needed further surgery for empyema (9 patients required open drainage or thoracoplasty, and 7 patients needed redecortication or repair of bronchopleural fistula). There were no intraoperative deaths and only eight (3.4%) perioperative deaths (< 30 days), which were mostly unrelated to surgery. Of the 234 patients, 202 patients (86.3%) achieved satisfactory results with VATS treatment. Patients requiring open decortication or repeat procedures (40 patients) had a longer mean duration of preoperative symptoms, longer mean duration of preoperative hospitalization, and a higher ratio of pleural empyema (vs complicated parapneumonic effusion) than patients undergoing simple VATS.


CONCLUSIONS
VATS is safe and effective for treatment of complicated parapneumonic effusion and pleural empyema. Earlier intervention with VATS can produce better clinical results. A prospective study should be done to identify optimal timing and settings for VATS treatment for both complicated parapneumonic effusion and pleural empyema.
Luh
Shi-Ping
SP
Department of Medicine, Chung-Shan Medical University Hospital, No 110, Sec 1, Chien-Kuo N. Rd, Taichung, Taiwan 402 ROC. luh572001@yahoo.com.tw
Chou
Ming-Chih
MC
Wang
Liang-Shun
LS
Chen
Jia-Yuh
JY
Tsai
Tsong-Po
TP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000150:complications / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted