Video-thoracoscopic and open surgical management of thoracic empyema.
OBJECTIVE
To evaluate the outcomes of video-thoracoscopic and open surgical management of patients with thoracic empyema.


METHODS
We studied 122 patients retrospectively who underwent surgery for thoracic empyema in our hospital between January, 1999 and January, 2005. Patients' medical records, surgical procedures, and outcomes were reviewed. The study identified 97 affected men and 25 affected women with a mean age of 54 years (range 16-78 years). The empyema was parapneumonic in 95 patients (78%).


RESULTS
Forty-four patients who had stage II empyema underwent video-assisted thoracic surgery (VATS). The procedure was converted to thoracotomy in 13 patients (29.5%); the morbidity and mortality rates of VATS were 13% and 0, respectively. Seventy-eight patients had stage III empyema and, along with those 13 who were converted, underwent thoracotomy for decortication. The associated morbidity rate was 12%, and the mortality rate was 6.6%. Thoracotomy was considered successful in 90 of 91 patients (99%); one patient needed a reoperative thoracotomy for an organ space/surgical site infection with pus in the pleural cavity.


CONCLUSIONS
Many treatment modalities are available for thoracic empyema, depending on the results of appropriate clinical and laboratory investigations. In fibrinopurulent empyema, VATS debridement is safe and effective, with minimal morbidity and no deaths. Lung decortication via thoracotomy is the only option for organized empyema and is associated with a substantial mortality rate.
Potaris
Konstantinos
K
Department of Thoracic Surgery, General Hospital of Attica KAT, Kifissia, Greece. Konstantinospotaris@yahoo.com
Mihos
Petros
P
Gakidis
Ioannis
I
Chatziantoniou
Christos
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D003646:Debridement; D016724:Empyema, Pleural / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000601:surgery; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D016896:Treatment Outcome