Thoracoscopic decortication for stage III empyema; a minimal invasive approach in a delayed presentation disease

Background

Stage III empyema still a problem that thoracic surgeons should deal with. We try to reduce the postoperative pain and hospital stay for those patients with using a minimal invasive approach in every case.

Methods

Prospective study of all cases assigned for one surgeon with diagnosis of turbid and/or hemorrhagic pleural effusion that showed loculations with thick peal or failed simple chest tube drainage admitted to our thoracic surgery service. An informed consent was taken of a trial for thoracoscopic procedure (VATS) with the possibility of open surgery in case that thoracoscopy fail to proceed. Operative technique was to completely remove the fibrous peel at the surface of the lung without parietal decortication.

Results

Forty-seven patients who met the inclusion criteria were assigned for the study, 38 males and 9 females. Mean age was 45.32 (17-82 years). Twenty-eight cases need only drainage and debridement with lysis of fine adhesions without the need for visceral decortication. The remaining 19 cases were subjected to VATS decortication. Of the 19 cases of decortication, 2 cases (10.52%) need conversion to open thoracotomy and one case converted from uniportal to 2 ports approach. All cases of decorication were discharged with mean drainage days of 5.42 (2-30 days). Mean operative time for decortication cases was 116.68 min (86-140 min).

Conclusions

Stage III empyema is no longer an absolute contraindication for VATS with the fact that not all cases with a preoperative diagnosis of stage III empyema might need decortication. Moreover, VATS decortication is feasible with a reasonable operative time, short hospital stay and no mortality compared to historical control.