Video-assisted thoracoscopy in the treatment of pleural empyema: Stage-based management and outcome

Cassina, Paolo C.; Hauser, Markus; Hillejan, Ludger; Greschuchna, D; Stamatis, Georgios

doi:10.1016/s0022-5223(99)70417-4

Cited by 155 publications

(95 citation statements)

References 10 publications

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“…Usually clinical findings are fever (60-86% of patients), chest pain (60%), dyspnea (47-74%), cough (31%), sputum production, poor appetite, weight loss (1,6,8). In our patients the main symptoms were fever, chest pain, dyspnea and cough.…”

Section: Discussionmentioning

confidence: 60%

“…Clinically it may provide better clues for the decision to perform the early surgical approach. The positive culture from the pleural space is assessed by different authors in 10-60% of patients (5,6,8,15,24,25,(28)(29)(30)(31)(32). Such a low percentage of positive cultures may represent an effective antibiotic treatment prior to sample collection.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, surgical management of pleural empyema plays an important role in the treatment of this disease, described already by Hippocrates (2-4). Traditionally, open thoracotomy represented the main stay of treatment for this condition, but recently numerous attempts have been performed to replace it by a minimally invasive approach (2,(5)(6)(7). The precise role of video-assisted thoracic surgery (VATS) in the management of pleural empyema remains controversial and no consensus is currently in place on which surgical option and for what the patient is the first line (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

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Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Jagelavičius¹,

Jovaišas²,

Matačiūnas³

et al. 2015

AML

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Background. Empyema remains a challenging entity for thoracic surgeons. The aim of this study was to evaluate preoperative predictors for unsuccessful thoracoscopic empyemectomy and postoperative complications.Materials and methods. There were 71 patients prospectively included in the study during the period from January 2011 to June 2014 in whom we performed thoracoscopic empyemectomy. Two main outcomes were evaluated: conversion and complications. Preoperative factors that could predict these outcomes were analyzed.Results. Conversion to open thoracotomy was required in 25.4% of cases. Fourteen (19.7%) patients had postoperative complications. The multivariate analysis showed that the time of illness (odds ratio 1.1; confidence interval 1.1-1.2), normal temperature on admission (odds ratio 11.2; confidence interval 1.5-85.4) and frank pus found on thoracocentesis (odds ratio 6.9; confidence interval 1.6-29.4) had a significant influence on conversion from thoracoscopy to open thoracotomy. Pain (odds ratio 0.01; confidence interval <0.01-0.6), subfebrile temperature on admission (odds ratio 10.1; confidence interval 1.4-73.5), positive pleural culture (odds ratio 8.5; confidence interval 1.0-70.1), Charlson comorbidity index (odds ratio 2.3; confidence interval 1.1-4.8), empyema volume (odds ratio 1.002; confidence interval 1.000-1.005) and empyema density (odds ratio 0.8; confidence interval 0.6-1.0) had a significant influence on postoperative complications.Conclusions. Longer time of illness, normal temperature on admission and frank pus in pleural aspiration increase probability of conversion. No pain, subfebrile temperature, higher Charlson comorbidity index on admission, positive pleural culture, higher volume and lower density of empyema on computed tomography scan increase probability of postoperative complications.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Jagelavičius¹,

Jovaišas²,

Matačiūnas³

et al. 2015

AML

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“…The advent of video-assisted thoracic surgery (VATS) for the management of fibrinopurulent stage II empyema has shown rewarding results in several reports. [6][7][8][9][10][11][12] VATS has the advantage to be less invasive than open decortication and to have a better acceptance by the patient.…”

Section: Discussionmentioning

confidence: 99%

Paediatric empyema: video-assisted thoracoscopic surgery (vats) and its outcome study

Manasa

Swetha

Yashoda

et al. 2017

Int J Contemp Pediatr

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Background: Empyema thoracis defined as purulent pleural effusion is a common condition in children with significant morbidity and mortality. The aim of therapy for empyema is to ensure rapid recovery with a normal long term pulmonary outcome. VATS (Video-assisted thoracoscopic surgery) is gaining acceptance as a primary modality of treatment in cases of early empyema. VATS is associated with decreased morbidity and reduced hospital stay of the patient. Methods: This is a retrospective observational study conducted in the department of pediatrics KIMS Hospital, Bengaluru from November 2014 to November 2016. In this study, review of the medical records of all the children aged 2 months to 18 years, who underwent VATS for empyema was done. The children included in the study were diagnosed with empyema thoracis based on chest X- ray, USG chest and CT chest and have undergone VATS by pediatric surgical team. Results: The median age of presentation was 4.1 yrs. 18 children were malnourished of which 3 had severe malnutrition. Male to female ratio was 1:1. Most common symptoms were fever (96%), cough (84%), respiratory distress (61%) and chest pain (48%). All patients had parapneumonic effusions and received antibiotics before undergoing surgery. Post-operative supplemental oxygen was required for 2.5±0.5 days. Chest tubes were removed in 4.53±0.7days and duration of stay in hospital was 8.26±1.77 days. All patients were afebrile before discharge and were discharged on oral antibiotics. Follow-up data showed that symptoms resolved in 24 children, 2 children had complications, one child had a pneumothorax and another had a broncho-pleural fistula. Results: Most common symptoms were fever (96%), cough (84%), respiratory distress (61%) and chest pain (48%). All patients had parapneumonic effusions and received antibiotics before undergoing surgery. Post-operative supplemental oxygen was required for 2.5±0.5 days. Chest tubes were removed in 4.53±0.7days and duration of stay in hospital was 8.26±1.77 days. All patients were afebrile before discharge and were discharged on oral antibiotics.Conclusions: These results suggest that primary operative therapy in the form of VATS is an effective treatment option for children with empyema. VATS is associated with a lower in-hospital mortality rate, re-intervention rate, length of stay and duration of tube thoracostomy.

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“…This process can be performed with VATS in the clinics not having the opportunity of MT. During the procedure of VATS, partial decortication can also be performed (47). In patients with mediastinitis, surgical treatment is absolutely needed.…”

Section: Medical Thoracoscopy In the Treatment Of Parapneumonic Pleurisymentioning

confidence: 99%

Medical thoracoscopy at 105. Anniversary

Metintaş¹

2015

Eurasian J Pulmonol

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Medical thoracoscopy (MT) for cases of exudative pleural effusion without a diagnosis by either clinical, radiological, laboratory or cytological investigation is performed as an established diagnostic method for the diagnosis of pleural diseases which has been performed routinely in many clinics. MT was done mainly with a rigid thoracoscope under mild sedation and local anesthesia in an endoscopy room with basic monitoring. It allows for the direct inspection of the pleural space and biopsies taken under direct vision. The diagnostic yield is in the order of 90-95% for malignant disease and can be as high as 100% for pleural tuberculosis. Additionally, MT can be performed for therapeutic as well as diagnostic purposes. Although MT remains an invasive procedure, complications are infrequently seen. Due to both the advantages of MT and the gradually increasing incidence of mesothelioma and malignant pleural disease, the use of MT for pleural effusions will be increasing in pulmonary clinics in coming years. Additionally MT will have some new developments; such as semirigid thoracoscopy, florescent or auto-florescent thoracoscopy, narrow-band imaging, thoracoscopy in patients without pleural effusion.

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Video-assisted thoracoscopy in the treatment of pleural empyema: Stage-based management and outcome

Cited by 155 publications

References 10 publications

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Paediatric empyema: video-assisted thoracoscopic surgery (vats) and its outcome study

Medical thoracoscopy at 105. Anniversary

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