TREATMENT OF EARLY PARAPNEUMONIC EMPYEMA BY MEDICAL THORACOSCOPY

We report on a consecutive series of 16 patients with complicated para pneumonic effusion or empyema, in whom, after a failed attempt at tube drainage, thoracoscopy under local anesthesia (''medical'' thoracosco py) was performed for debridement and placement of a chest tube. This approach led to immediate clinical improvement in all patients and to definitive cure in 12 of 16. In 4 patients open surgical debridement w as necessary after a few days in an elective procedure. In a subgroup of thoracoscopically treated patients lung function tests were perform ed at least 6 months after the procedure and did not demonstrate signi ficant restrictive changes. We conclude that thoracoscopy under local anesthesia is a valuable addition to the treatment options in patients with multiloculated, complicated parapneumonic effusion or empyema no t responsive to simple tube thoracotomy. The procedure is less taxing for the patient and less expensive than video-assisted thoracoscopic s urgery under general anesthesia or open decortication.