Outcomes of Video-Assisted Thoracic Surgical Decortication in 274 Patients with Tuberculous Empyema

Abstract

Objective: The present work aimed to retrospectively assess the outcomes associated with decortication by video-assisted thoracic surgery (VATS) in patients with tuberculous empyema. Methods: Patients (n = 274) who underwent decortication by VATS for surgical management of pleural empyema between January 2000 to 2010 were included. Pre-, intra-, and postoperative characteristics were observed for all patients, which were followed up for 12 months to evaluate surgical outcomes such as postoperative complications and disease recurrence. Results: No patients required conversion to thoracotomy, and no death or postoperative bleeding was reported. The mean operation time was 104.5 ± 20.4 min, with 271.5 ± 41.3 ml intraoperative blood loss and median length of hospital stay of 7.2 ± 3 .4 days. Of the 274 patients, 262 were followed up for 12 months; 26 (9.9%) patients showed complications, including incomplete lung re-expansion (11 patients) and persistent air leak (6 patients). While early disease recurrence was observed in 3 (1.1%) patients after surgery, late recurrence was reported for 6 (2.3%) individuals. Interestingly, the complication rate was much higher in patients with chronic empyema (15/34, 44.1%) than in subjects with acute empyema (11/228, 4.8%). Conclusions: Decortication by VATS decreases postsurgical complications, and results in decreased disease recurrence. This study demonstrated improved outcomes by decortication by VATS, even in patients with stage III tuberculous empyema.

Outcomes after implementing the enhanced recovery after surgery protocol for patients undergoing tuberculous empyema operations

“…This reduction is in agreement with a previous study of outcomes of tuberculous empyema operations (9). However, there is still lack of information about the role of ERAS protocols in patients undergoing tuberculous empyema operations.…”

Tuberculous pleural effusion

“…Instillation of intrapleural fibrinolytics has a role to play in the treatment of TB empyema; however, surgical intervention is often required to control infection and prevent progression to fibrothorax. Traditionally, open thoracotomy with decortication (removal of thickened visceral and parietal pleural peel) has been the intervention of choice for patients in whom pleural peel has been present for months and who have symptoms related to restriction or trapped viable lung; however, recent data have demonstrated good outcomes with video‐assisted thoracic surgery (VATS) decortication . Kumar et al .…”

“…Traditionally, open thoracotomy with decortication (removal of thickened visceral and parietal pleural peel) has been the intervention of choice for patients in whom pleural peel has been present for months and who have symptoms related to restriction or trapped viable lung; however, recent data have demonstrated good outcomes with video-assisted thoracic surgery (VATS) decortication. 28,100,101 Kumar et al performed VATS decortication in 90 patients with stage III TB empyema. There were no perioperative deaths amongst the cohort, and the morbidity rate of 33% was composed mainly of persistent air leak.…”

Minimally invasive thoracic surgery for empyema

“…VATS seems to be a safe and accurate procedure to obtain a satisfactory toilet, as reported by C hen et al . [ 35 ] in a study involving 274 patients with empyema secondary to tuberculosis. These authors noted an early recurrence or relapse (elevated temperatures between 38.5°C and 39.5°C and re-effusion with fibreboard) in three patients (1.1%) and a late one in six patients (2.3%) (re-effusion and surgical site infection after 6 months of intervention).…”