Timing and Efficacy of VATS Debridement in the Treatment of Parapneumonic Empyema

Henrietta Wilson*, Prashant Mohite, Anne Hall and Vladimir Anikin

Objectives: Empyema thoracis is a common thoracic disease seen in both developing and developed countries. Despite modern management techniques, this condition is still associated with significant morbidity and mortality. Video assisted thoracoscopic surgery (VATS) has become an established mode of treatment for this condition; however the first-line approach and timing of surgical intervention remains controversial. The present study was undertaken to assess our experience of VATS debridement in the management of empyema, focusing on the timing of surgical intervention, and the affect this has on outcomes.

Method: Between May 2007 and May 2011, 75 patients underwent VATS debridement of empyema in  our institution. Retrospective analysis of clinical notes was performed to collect data regarding length of pre-operative conservative management, operative strategy and post-operative course. The primary outcomes were the need for open thoracotomy, post-operative complications, length of hospital stay and survival.

Results: The mean pre-operative duration of conservative management in this cohort was15.7 days (range 4-35). A total of 9 patients (12%) required open thoracotomy. Patients who had been managed conservatively for two weeks or more were significantly more likely to require open thoracotomy (p > 0.05). Both approaches were well tolerated with minimal post-operative complications. Average length of stay was 8.2 days (range 2-38) with no correlation found between this and pre-operative length of management. There were no in hospital deaths following this procedure.

Conclusions: VATS is now fully established as a safe and effective approach in the management of patients with empyema. The timing of any surgical intervention, however, remains controversial. There appears to be an ongoing trend for delayed referral, with the majority of our patients managed conservatively for over two weeks. The current study supports early surgical involvement, as later referral has been shown to lead to a significant increase in the need for open thoracotomy.

Keywords: Emypema; VATS

Published on: Jun 30, 2016 Pages: 16-19

Full Text PDF Full Text HTML DOI: 10.17352/aprc.000010
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