The role of thoracoscopic debridement in the treatment of parapneumonic empyema

Abstract

Video-assisted thoracoscopic debridement provides a high success rate and less invasive treatment for the early stages of empyema.

Factors Affecting Postoperative Lung Expansion in Patients with Pyogenic Empyema

“…[1][2][3] In patients unlikely to tolerate decortication, debridement may afford adequate drainage. 4,5 However, decortication is usually preferred to ensure adequate functional lung re-expansion; this is the standard treatment. 1,3,[6][7][8] Unfortunately, repeat surgery, or prolonged chest tube drainage and antibiotic administration, may be unavoidable Keywords ► pleural space ► pleural air leak/ effusion ► thoracoscopy/VATS…”

Thoracoscopic management of early stages of empyema: is this the golden standard?

“…The rate of conversion to open thoracotomy and decortication during the thoracoscopy procedure has varied between studies from 8.2% to 17.1% (6,12,13). We believe our rate of conversion was nil because of performing most procedures at an early stage and acceptance of a small pneumothorax at the end of the procedure which usually self resolves with the healing process as the lung compliance improves.…”

“…Group A which was managed by the chest physicians comprised 28 patients while group B managed by the surgeons comprised 38 patients. [2][3][4][5][6][7][8][9][10][11][12][13][14]. Mean hospital cost per patient was 3,100$ (1,400$-15,630$).…”

“…There was no mortality and no patient suffered from any major morbidity but 2 patients suffered from superficial wound infection and one patient from lung entrapment. During a mean follow up period of 8 months [6][7][8][9][10][11][12][13][14], two patients (5.3%) required reoperation and a decortication via a thoracotomy at 8 and 12 weeks after the VATS procedure. Both patients had been referred late at 21 and 24 days from onset of symptoms but were given a trial of thoracoscopic drainage.…”

Intrapleural fibrinolysis and DNase versus video-assisted thoracic surgery (VATS) for the treatment of pleural empyema (FIVERVATS): protocol for a randomised, controlled trial – surgery as first-line treatment

“…However, neither study had a size or methodological quality that makes it possible to conclude whether surgery, especially minimal invasive surgery as VATS, should be included as part of the standard treatment of pleural empyema. [9][10][11][12] The theoretical advantage of surgery as first line treatment is in providing rapid, definitive treatment and insuring optimal drain placement. Experience so far suggest reduction in mortality, LOS, and late complications.…”