Video-assisted thoracic surgery for pleural empyema.
BACKGROUND
After we gained considerable experience with video-assisted thoracic surgery (VATS) and became familiar with its advantages, we started to use it for the treatment of thoracic empyema.


METHODS
We treated 130 patients with pleural empyema in whom chest tube drainage and antibiotic therapy had failed to produce a satisfactory result. Six months after surgery they had clinical and radiologic assessment and spirometry.


RESULTS
Video-assisted surgery was performed in all patients. Mean operative time was 93 minutes (range, from 55 to 180 minutes), mean duration of postoperative chest tube drainage was 10 days (range, from 5 to 32 days), and mean hospital stay was 16 days (range, from 3 to 56 days). The rate of conversion to open thoracotomy was 3.1%. Complications for which reoperation was necessary occurred in 9% of patients. At follow-up after six months, the mean forced expiratory volume in 1 second was 87.7% (range, from 69.5% to 105.9%), the mean postoperative vital capacity was 84.4%, (range, from 59.9% to 97.9%). There were no postoperative or procedure-related deaths.


CONCLUSIONS
Video-assisted thoracic surgery is a safe and effective treatment option for fibropurulent empyema with low morbidity and mortality. Conversion to thoracotomy should be used if necessary to remove all of the fibropurulent material and achieve complete expansion of the lung to insure a good outcome.
Wurnig
Peter N
PN
Department of Thoracic Surgery, Otto-Wagner Hospital, Vienna, Austria. peter.wurnig@wienkav.at
Wittmer
Victoria
V
Pridun
Nestor S
NS
Hollaus
Peter H
PH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015505:Chest Tubes; D003131:Combined Modality Therapy; D016724:Empyema, Pleural / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013147:Spirometry; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014797:Vital Capacity
D000900:Anti-Bacterial Agents