Videothoracoscopic debridement of the postpneumonectomy space in empyema

Abstract

Videothoracoscopic debridement of the postpneumonectomy space with postoperative antibiotic irrigation of the pleural space is an efficient method to treat postpneumonectomy empyema, provided that a concomitant bronchopleural fistula can be closed successfully. No early empyema or fistula recurrence were observed. However, late recurrence may occur many years after operation, therefore close follow-up is indicated.

Irrigation with antibiotic-containing solutions for the prevention and treatment of infections

“…The initial steps of treatment include tube thoracostomy drainage and the intravenous administration of antibiotics. Hollaus et al [22] treated empyema by videothoracoscopic debridement of the post-pneumonectomy space, with post-operative antibiotic irrigation of the pleural space. Previously, a concomitant bronchopleural fistula was closed with bronchoscopic sealing to avoid aspiration of the instilled solution.…”

Video-thoracoscopic management of a postpneumonectomy bronchopleural fistula

“…We thoracoscopically removed all debris and the infl ammatory tissues of the empyema following the basic principles of the Clagett procedure and sealed the small BPF, thereby avoiding reinfection of the postpneumonectomy space via a remaining open fi stula. 5 The management of BPF depends on the patient's general condition, the presence of empyema, the size of the fi stula, and the surgical options. 1,6 When a simple empyema coexists with a small BPF, initial aggressive surgical treatment has not proven to be more effective than the Clagett procedure or simple pleural rinsing.…”

“…1,6 When a simple empyema coexists with a small BPF, initial aggressive surgical treatment has not proven to be more effective than the Clagett procedure or simple pleural rinsing. 5 The VATS option of the Clagett procedure offers a less invasive method than the open approach. Furthermore, open thoracostomy is uncomfortable for the patient, requiring a second operation for closure or in some cases awaiting spontaneous closure or remaining permanent.…”

Management of Complications After Pneumonectomy

“…Patients who present in the first month after pneumonectomy can often be managed by a thoracoscopic debridement of the pleural space and washout followed by postoperative irrigation with antibiotics for 5 days. 39,76 For patients who present with an empyema in the first few weeks after EPP with a degree of infection too advanced for thoracoscopic washout, the authors' practice is for an early Clagett window, with removal of the PTFE pericardial and diaphragmatic patches in a staged fashion due to the risk of herniation of the heart or abdominal contents if these patches are removed too early. After 2 to 4 weeks of dressing changes, the mediastinum is usually sufficiently scarred in to allow removal of the pericardial patch without the risk of cardiac herniation.…”