The Physiologic and Radiologic Outcomes of Decortication for Chronic Empyema in the Long Term Follow Up: A Retrospective Analysis

Abstract

Aim: Chronic empyema due to non-specific or tuberculosis lead to both decrease in pulmonary functions and distortions of the radiologic views. Decortication either through video assisted thoracic surgery (VATS) or open thoracotomy is the last resort of treatment. The study aims to evaluate the spirometry and radiologic outcomes of decortication of patients with chronic empyema. Material and Method: The study included all patients who had decortication due to thoracic empyema between 2010 and 2016. Besides routine clinical evaluation spirometry analyses and radiologic evaluation with thoracic computerized tomography (CT) were performed in all patients. Either open thoracotomy with muscle sparing technique or VATS were performed to remove thickened parietal pleura and to decorticate the thickened pleura trapping the lung parenchyma. Change in the spirometry parameters were calculated. The improvement in the radiologic appearance were classified as satisfactory, moderately satisfactory, and unsatisfactory. Results: A total of 104 patients comprised the study population. Sixty-eight of the cases (65%) were male and the mean age of patients was 38.61±17.38 years. Operation site was equally distributed. Non-specific microorganisms were the dominant etiologic agents rather tuberculosis. All spirometry parameters improved significantly. Both forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) values increased after the decortication significantly. All patients were followed at least for 2 years. Most of the cases showed satisfactory results (92 cases, 88%), 9 patients improved moderately (8.6%), and only 3 patients (3%) had unsatisfactory radiologic evaluation. Conclusion: Decortication either through open thoracotomy or VATS approach is very effective treatment method to improve the spirometry parameters and restore the distorted radiologic appearances in patients with chronic empyema.

Pleural empyema management: The impact of Video-assisted thoracoscopic surgery

“…When loculated pleural effusions occur, surgical interventions should be used aggressively to ensure lung expansion [9,10]. It has been demonstrated that lung expansion can be achieved successfully and with a less invasive surgery compared to thoracotomy, with rapid decision-making and early VATS application, primarily in stage 2 empyema when lung expansion cannot be achieved after tube thoracostomy [9][10][11][12][13]. In addition, studies are reporting that thoracoscopic debridement reduces morbidity by providing early recovery in the treatment of advanced empyema [14].…”

Role of Anti-Tuberculous Treatment in the Outcome of Decortication for Chronic Tuberculous Empyema

“…It cannot be treated with anti-tuberculous drugs alone and needs surgical evacuation of the pus. Surgical techniques range from tube thoracostomy, intrapleural fibrinolytics, open window thoracostomy to thoracotomy and decortication [ 7 , 8 ]. These surgical techniques are recommended in conjunction with chemotherapy like anti-tuberculosis therapy (ATT) in cases of CTE.…”