Effect of Circumference of Open Window Thoracostomy on Chest Wall Closure, Pleural Cavity Clearance, and Lung Expansion

Abstract

IntroductionManaging chronic empyema thoracis (CET) due to tuberculosis (TB) in debilitated patients is complicated. Open window thoracostomy (OWT) is one of the ways to manage these high-risk patients. Closure of OWT is sometimes difficult to attain. The purpose of this study is to compare the outcome of OWT in terms of chest wall closure in two similar groups. The only difference between these groups was the circumference of the OWT created. This study will benefit patients of CET with OWT to attain early chest wall closure without being subjected to another surgical trauma. MethodsThis is a prospective comparative study, conducted in the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, from August 2019 to July 2020. A total of 48 patients, 22 and 26 patients in group A and group B, respectively, were included in this study. Both groups were matched for age, gender, diagnosis, body mass index, and stage of empyema, with the difference only in the OWT circumference. ResultsBoth groups had a history of multiple chest tube intubations. Among group A patients, a smaller circumference of OWT (20-24 cm; mean 22 cm) was created as compared to group B (30-34 cm; mean 33 cm). Spontaneous OWT closure was seen in 21 (95.5%) patients in group A and seven (26.9%) patients in group B in a time period of 6.2 ± 1.5 and 11.4 ± 0.5 months, respectively (p-value: ≤ 0.001). Pleural cavity clearance was attained in 21 (95.5%) patients in group A and 24 (92.35%) patients in group B in a time duration of 4 ± 1.4 months and 4 ± 4.1 months, respectively (p-value: ≤ 0.97). Complete lung expansion was found in 21 (95.5%) patients in group A and 24 (92.3%) patients in group B in a time duration of 5 ± 1.7 months and 4.7 ± 1.6 months, respectively (p-value: ≤ 0.62). ConclusionThis prospective single-center study shows that successful spontaneous early closure of OWT primarily depends on the size of the OWT created. A smaller-sized OWT, if created judiciously, not only closes spontaneously but also facilitates the clearance of purulent discharge and potentially helps in the definitive healing of bronchopleural fistulae and consequent lung expansion, thereby avoiding more invasive procedures like decortication in a debilitated patient. Furthermore, there is no need for a second surgery for closure of OWT.