title: Surgery for thoracic empyema: personal experience and current highlights.
abstract: Thoracic empyema remains challenging for thoracic surgeons. The principles of empyema treatment are early diagnosis and early treatment. Decision-making involves a triad consisting of the etiology of empyema, general condition of the patient and stage of disease. For acute empyema, early surgical intervention, such as video-assisted thoracoscopic debridement, is recommended when conventional chest tube drainage has failed. Radical treatments of chronic empyema include 1 removal of the empyema space (decortication with or without lung resection) and 2 obliteration of the pleural space with muscle flaps or omentum flaps, or by thoracoplasty. Decortication is the procedure of choice for patients with re-expandable underlying lung. For patients who are not eligible for the above-mentioned radical treatment, open-window thoracostomy can be considered. The current attitudes show that the present concepts are based mainly on expert opinion. No exclusive sequence of procedures leading to a uniformly predictable successful outcome is available. Individualized approaches can be recommended based on institutional practice and local protocols.
authors: Serviço de Cirurgia Cardiotorácica do Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.
authors: Miguel
authors: M
authors: Guerra
authors: Paulo C
authors: PC
authors: Neves
authors: Daniel
authors: D
authors: Martins
authors: José
authors: J
authors: Miranda
authors: Francisco
authors: F
authors: Leal
authors: Luis
authors: L
authors: Vouga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods; D003657:Decision Making; D004322:Drainage / Q000379:methods; D016724:Empyema, Pleural / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013905:Thoracoplasty / Q000379:methods*; D013907:Thoracostomy / Q000379:methods*; D055815:Young Adult