HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Angelillo Mackinlay, T. A. Articles by Emery, J. Search for Related Content PubMed PubMed Citation Articles by Angelillo Mackinlay, T. A. Articles by Emery, J. Related Collections Related Article

Ann Thorac Surg 1996;61:1626-1630
© 1996 The Society of Thoracic Surgeons

---

Original Article: General Thoracic

VATS Debridement Versus Thoracotomy in the Treatment of Loculated Postpneumonia Empyema

Division of Thoracic Surgery, British Hospital, Buenos Aires, Argentina

Accepted for publication January 30, 1996.

Background. There are approximately 60,000 new cases of postpneumonic empyema every day in the United States. Usually the fibrinopurulent stage of this complication has been treated by either tube thoracostomy or thoracotomy and debridement. According to the literature, thoracoscopic treatment has not been used often for this disease.

Methods. Sixty-four cases of postpneumonic fibrinopurulent empyema were operated on at our institution: 33 cases (group I) by means of a formal thoracotomy and 31 cases (group II) by thoracoscopy. In the thoracoscopic subset the data were collected prospectively since 1992. These results were compared with those of a historical series treated by thoracotomy between 1985 and 1991. Both populations were similar in terms of age (mean, 49 years), number of cases (33/31), sex (2.1 male/female), and comorbid status.

Results. Mean preoperative length of the medical management (11.5 versus 17 days) (p = 0.03) and chest tube removal (4.3 versus 6.1 days) were shorter in group II than in group I (p = 0.02). Morbidity and mortality were identical: one death and five complications in each group. Mean operative time was similar in both groups, and hospital stay was shorter in the video-assisted thoracic surgery group (6.8 versus 11.2 days) (p = not significant). Three patients from group II needed utilitary thoracotomies for debridement completeness (10% conversion rate).

Conclusions. We conclude that video-assisted thoracic surgical treatment has the same rate of success as open thoracotomy but offers substantial advantages over thoracotomy in terms of resolution of the disease, hospital stay, and cosmesis. A prospective and randomized study is needed to confirm the findings of this nonrandomized initial experience.

Related Article

Invited Commentary

Joseph I. Miller, Jr
Ann. Thorac. Surg. 1996 61: 1630. [Extract] [Full Text]

This article has been cited by other articles:

				D. T.L. Chan, A. D.L. Sihoe, S. Chan, D. S.F. Tsang, B. Fang, T.-W. Lee, and L.-C. Cheng Surgical Treatment for Empyema Thoracis: Is Video-Assisted Thoracic Surgery "Better" Than Thoracotomy? Ann. Thorac. Surg., July 1, 2007; 84(1): 225 - 231. [Abstract] [Full Text] [PDF]

				F. Farjah, R. G. Symons, B. Krishnadasan, D. E. Wood, and D. R. Flum Management of pleural space infections: A population-based analysis J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 346 - 351. [Abstract] [Full Text] [PDF]

				G. F. Tassi, R. J. O. Davies, and M. Noppen Advanced techniques in medical thoracoscopy. Eur. Respir. J., November 1, 2006; 28(5): 1051 - 1059. [Abstract] [Full Text] [PDF]

				H.-B. Ris and T. Krueger Video-assisted thoracoscopic surgery and open decortication for pleural empyema MMCTS, January 9, 2006; 2006(0109): 273. [Abstract] [Full Text] [PDF]

				P. N. Wurnig, V. Wittmer, N. S. Pridun, and P. H. Hollaus Video-Assisted Thoracic Surgery for Pleural Empyema Ann. Thorac. Surg., January 1, 2006; 81(1): 309 - 313. [Abstract] [Full Text] [PDF]

				R. W. Light Parapneumonic effusions and empyema. Proceedings of the ATS, January 1, 2006; 3(1): 75 - 80. [Abstract] [Full Text] [PDF]

				D. Lardinois, M. Gock, E. Pezzetta, C. Buchli, V. Rousson, M. Furrer, and H.-B. Ris Delayed Referral and Gram-Negative Organisms Increase the Conversion Thoracotomy Rate in Patients Undergoing Video-Assisted Thoracoscopic Surgery for Empyema Ann. Thorac. Surg., June 1, 2005; 79(6): 1851 - 1856. [Abstract] [Full Text] [PDF]

				S.-P. Luh, M.-C. Chou, L.-S. Wang, J.-Y. Chen, and T.-P. Tsai Video-Assisted Thoracoscopic Surgery in the Treatment of Complicated Parapneumonic Effusions or Empyemas: Outcome of 234 Patients Chest, April 1, 2005; 127(4): 1427 - 1432. [Abstract] [Full Text] [PDF]

				I M Balfour-Lynn, E Abrahamson, G Cohen, J Hartley, S King, D Parikh, D Spencer, A H Thomson, D Urquhart, and on behalf of the Paediatric Pleural Diseases Subco BTS guidelines for the management of pleural infection in children Thorax, February 1, 2005; 60(suppl_1): i1 - i21. [Full Text] [PDF]

				C. Ozcelik, R. Ulku, S. Onat, Z. Ozcelik, I. Inci, and O. Satici Management of postpneumonic empyemas in children Eur. J. Cardiothorac. Surg., June 1, 2004; 25(6): 1072 - 1078. [Abstract] [Full Text] [PDF]

				T. L. Ray, J. W. Berkenbosch, P. Russo, and J. D. Tobias Tissue Plasminogen Activator as an Adjuvant Therapy for Pleural Empyema in Pediatric Patients J Intensive Care Med, January 1, 2004; 19(1): 44 - 50. [Abstract] [PDF]

				C. Ozcelik, I. Inci, O. Nizam, and S. Onat Intrapleural fibrinolytic treatment of multiloculated postpneumonic pediatric empyemas Ann. Thorac. Surg., December 1, 2003; 76(6): 1849 - 1853. [Abstract] [Full Text] [PDF]

				J. R. Roberts Minimally invasive surgery in the treatment of empyema: intraoperative decision making Ann. Thorac. Surg., July 1, 2003; 76(1): 225 - 230. [Abstract] [Full Text] [PDF]

				D. A. Waller and A. Rengarajan Thoracoscopic decortication: a role for video-assisted surgery in chronic postpneumonic pleural empyema Ann. Thorac. Surg., June 1, 2001; 71(6): 1813 - 1816. [Abstract] [Full Text] [PDF]

				G. B. Hammer Pediatric Thoracic Anesthesia Anesth. Analg., June 1, 2001; 92(6): 1449 - 1464. [Full Text] [PDF]

				G. L. Colice, A. Curtis, J. Deslauriers, J. Heffner, R. Light, B. Littenberg, S. Sahn, R. A. Weinstein, and R. D. Yusen Medical and Surgical Treatment of Parapneumonic Effusions : An Evidence-Based Guideline Chest, October 1, 2000; 118(4): 1158 - 1171. [Abstract] [Full Text] [PDF]

				S. Sasse, T. Nguyen, L. R. Teixeira, and R. Light The Utility of Daily Therapeutic Thoracentesis for the Treatment of Early Empyema* Chest, December 1, 1999; 116(6): 1703 - 1708. [Abstract] [Full Text] [PDF]

				A. P.C. Yim Paradigm Shift in Empyema Management Chest, March 1, 1999; 115(3): 611 - 612. [Full Text] [PDF]

				H.-C. Huang, H.-Y. Chang, C.-W. Chen, C.-H. Lee, and T.-R. Hsiue Predicting Factors for Outcome of Tube Thoracostomy in Complicated Parapneumonic Effusion or Empyema Chest, March 1, 1999; 115(3): 751 - 756. [Abstract] [Full Text] [PDF]

				P. C. Cassina, M. Hauser, L. Hillejan, D. Greschuchna, and G. Stamatis VIDEO-ASSISTED THORACOSCOPY IN THE TREATMENT OF PLEURAL EMPYEMA: STAGE-BASED MANAGEMENT AND OUTCOME J. Thorac. Cardiovasc. Surg., February 1, 1999; 117(2): 234 - 238. [Abstract] [Full Text] [PDF]

				H. Striffeler, M. Gugger, V. Im Hof, A. Cerny, M. Furrer, and H.-B. Ris Video-Assisted Thoracoscopic Surgery for Fibrinopurulent Pleural Empyema in 67 Patients Ann. Thorac. Surg., February 1, 1998; 65(2): 319 - 323. [Abstract] [Full Text] [PDF]