Management of Parapneumonic Effusion and Empyema: Medical Thoracoscopy and Surgical Approach

Kern, Lukas; Robert, John; Brutsche, Martin

doi:10.1159/000326337

Cited by 29 publications

(21 citation statements)

References 27 publications

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“…Both approaches remove pus and fluid from the pleural space and reduce the need for open drainage and decortication [62,63], and are associated with reduced morbidity compared to open thoracotomy [63,64]. However, children who undergo surgery still require a chest drain post-operatively and there is debate as to whether there is any reduction in hospital stay [65][66][67] compared with nonsurgical management.…”

Section: Parapneumonic Effusion/empyemamentioning

confidence: 99%

Complicated pneumonia in children

Pabary

Balfour‐Lynn

2013

BRE

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Section: Parapneumonic Effusion/empyemamentioning

confidence: 99%

Complicated pneumonia in children

Pabary

Balfour‐Lynn

2013

BRE

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“…It does not require general anesthesia and double-lumen intubation, which leads to shorter hospitalization times and yields better cosmetic results. Above all, it is a more advisable procedure in frail patients who have high levels of surgical risk (4,5). Although our study presents a small number of patients, the combined application of gastroscopy and thoracoscopy for the treatment of intrathoracic anastomotic leak may be an effective, safe and minimally-invasive procedure.…”

Section: Discussionmentioning

confidence: 92%

Medical thoracoscopy and gastroscopy for the treatment of intrathoracic anastomotic leakage following esophagectomy

Hu²,

Rong

et al. 2012

Oncology Letters

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Abstract. Intrathoracic anastomotic leakage following esophagectomy is extremely difficult to manage appropriately. The outcomes of conservative management strategies are often disappointing, particularly in patients who develop adhesions of the pleural cavity and multiloculated empyema. This study describes a novel approach using combined thoracoscopy and gastroscopy in two cases. Thoracoscopy under local anesthesia was used to dissect the septations within the multiloculated empyema and remove the infected focus by direct visualization, and gastroscopy was subsequently performed to place a nasogastric or sump tube around the leak. The outcomes of both procedures were satisfactory: the empyemas almost completely resolved, the anastomotic leak closed quickly and there was adequate lung re-expansion. Accordingly, the combination of thoracoscopy and gastroscopy for the treatment of intrathoracic anastomotic leak post-esophagectomy may be an effective, safe, minimally-invasive, simple and inexpensive procedure. IntroductionIntrathoracic anastomotic leakage is an extremely intractable complication that occurs following esophagectomy, with an incidence that ranges from 1.3 to 5.1% (1-3). The mortality rate is 12-46.2% (1-3). In general, the effect of conservative treatments, including conventional chest tube drainage, nasogastric decompression and nutritional support, is often poor, particularly in patients with adhesions of the pleural cavity and multiloculated empyema (1-4). This study describes the combined application of medical thoracoscopy followed by gastroscopy for the treatment of an intrathoracic anastomotic leak in two patients. The study was approved by the IRB of Sun Yat-sen University Cancer Center. Consent was obtained from both of the patients. Case reportsCase 1. A 58-year-old male patient with middle-third thoracic esophageal squamous carcinoma was confirmed to have an intrathoracic anastomotic leak 10 days after esophagectomy and a right-sided contained empyema 4 weeks after esophagectomy. The condition of the patient did not improve following jejunostomy, conventional chest tube drainage and gastrointestinal decompression for 8 weeks. Gastroscopy (Fig. 1A) confirmed that a large intrathoracic anastomotic leak existed in the posterior right-sided wall of the esophagus. Two nasogastric tubes were then respectively placed into the residual stomach and the sump around the leak. A computed tomography scan was performed prior to thoracoscopy in order to select the incision accurately to facilitate exploration, debridement and drainage. Thoracoscopy was then performed under continuous sedation and local anesthesia. The port was inserted through a trocar via an incision on the right mid-clavicular line, between the second and third intercostal spaces. These adhesions and septations were dissected with biopsy forceps and electrocautery. After removing the infected focus, the anastomotic leak could be observed at the upper pole of the empyema cavity with some refluxed stomach content. The lateral side of th...

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“…Treatment of empyema can be accomplished with an equal efficiency using pleuroscopy and video-assisted thoracoscopy surgery (VATS) [9][10][11]. Yet, treatement of patients with pleural infection by medical thoracoscopy may save money comparing to surgery, since the technique is less expensive [11,12] and better tolerated than VATS, which requires tracheal intubation [11].…”

Section: Discussionmentioning

confidence: 99%

Bilateral empyema treated by sequential pleuroscopy

Archontogeorgis

Lanfranco

Koulelidis

et al. 2016

Monaldi Arch Chest Dis

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Bilateral empyema associated to infectious pericarditis is an extremely rare, yet life-threatening condition. Pleuroscopy-medical thoracoscopy has proved its efficacy in series of patients with empyema. Yet, all reported cases treated by this technique, concerned patients with pleural infection located to a single hemithorax. We present the case of a 71-year-old man with bilateral empyema treated successfully by sequential pleuroscopy, associated to infectious pericarditis.

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Management of Parapneumonic Effusion and Empyema: Medical Thoracoscopy and Surgical Approach

Cited by 29 publications

References 27 publications

Complicated pneumonia in children

Complicated pneumonia in children

Medical thoracoscopy and gastroscopy for the treatment of intrathoracic anastomotic leakage following esophagectomy

Bilateral empyema treated by sequential pleuroscopy

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