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 Author home page(s): David R. Lawrence Edward R. Townsend Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lawrence, D. R. Articles by Fountain, S. W. Search for Related Content PubMed PubMed Citation Articles by Lawrence, D. R. Articles by Fountain, S. W.

Ann Thorac Surg 1997;64:1448-1450
© 1997 The Society of Thoracic Surgeons

---

Original Articles: General Thoracic

Thoracoscopic Debridement of Empyema Thoracis

Department of Thoracic Surgery, Harefield Hospital, Harefield, Middlesex, United Kingdom

Accepted for publication May 28, 1997.

Background. The primary treatment of empyema thoracis remains intercostal tube drainage together with antibiotics. Failure of primary treatment has until recently been an indication for thoracotomy and decortication. Video-assisted thoracoscopic debridement (VATD) has increased the available treatment options but requires validation.

Methods. A retrospective analysis was undertaken of 44 consecutive patients who presented for surgical treatment of empyema thoracis over a 3-year period.

Results. Two patients were unsuitable for VATD and were treated with open decortication (OD). Thirty patients were successfully treated by VATD. Two patients were converted to OD at the first operation, and 10 patients required OD as a second procedure. The mean duration of preoperative symptoms before referral was 37.6 ± 11.8 days (VATD) and 40.1 ± 11.6 days (OD) (p = not significant). The mean duration of hospitalization before transfer was 13.7 ± 2.4 days (VATD) and 11.5 ± 3.4 days (OD) (p = not significant). Intercostal drainage was required for 4.0 ± 0.3 days (VATD) and 8.5 ± 2.0 days (OD) (p = 0.004). The postoperative hospital stay was 5.3 ± 0.4 days (VATD) and 10.3 ± 2.1 days (OD) (p = 0.001).

Conclusions. Primary surgical therapy with VATD should be considered for all patients with pleural empyema, irrespective of the duration of symptoms. This approach does not preclude OD as a secondary procedure or conversion to OD after initial thoracoscopic assessment. The major advantages of VATD over OD are a shorter duration of postoperative intercostal drainage and reduced postoperative hospitalization.

This article has been cited by other articles:

				T. F. Molnar Current surgical treatment of thoracic empyema in adults Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 422 - 430. [Abstract] [Full Text] [PDF]

				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]

				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]

				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]

				C W H Davies, F V Gleeson, and R J O Davies BTS guidelines for the management of pleural infection Thorax, May 1, 2003; 58(90002): ii18 - 28. [Full Text]

				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. 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]

				D. R. Lawrence, S. K. Ohri, R. E. Moxon, E. R. Townsend, and S. W. Fountain Primary esophageal repair for Boerhaave's syndrome Ann. Thorac. Surg., March 1, 1999; 67(3): 818 - 820. [Abstract] [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]