VIDEOTHORACOSCOPY IN THE TREATMENT OF EARLY EMPYEMA - AN INITIAL EXPERIENCE

Seventeen consecutive patients were referred for management of empyema between April 1991 and March 1992. Fourteen patients defined as havin g an 'early' empyema were initially treated by videothoracoscopy. The other three patients, defined as having a 'late' empyema proceeded dir ectly to thoracotomy, Videothoracoscopy was successful in 10 out of th e 14 patients. The mean postoperative stay was 7.8 days. At a mean fol low-up at 16.7 months, these patients were rendered apyrexial with ful l lung expansion and no residual pleural collection. The postoperative results were at least equivalent to other conventional forms of treat ment without an undue level of complications. In this series, thoracos copy was found to be successful when symptoms had been present up to 3 1 days before presentation at the first hospital, and the mean length of treatment before referral to Harefield was 47 days. It is now our p olicy to videothoracoscope all patients with empyema thoracis, regardl ess of the length of referral. It may circumvent the need for a thorac otomy, it does not add any increased risk of complications, and does n ot appreciably increase the length of hospital stay should thoracotomy ultimately be required.