EARLY THORACOSCOPIC DEBRIDEMENT AND DRAINAGE AS DEFINITE TREATMENT FOR PLEURAL EMPYEMA

Objective: To report our experience with early thoracoscopic debrideme nt and drainage in the treatment of pleural empyema in the fibrinopuru lent or early organising phase. Design: Prospective open study. Settin g: District hospital, Germany. Subjects: 10 Patients operated on betwe en August 1991 and April 1993. Interventions: Double lumen intubation, followed by thoracoscopic opening of the empyema, evacuation of all p us under vision, debridement of the lung, irrigation of the thoracic c avity and insertion of a chest drain. Main outcome measures: Morbidity and mortality. Results: Cultures taken during the operation grew no p athogens in five cases; Streptococcus pneumoniae, and haemolytic strep tococci (once in combination with Staphylococcus aureus), were culture d in two cases each; and Mycobacterium tuberculosis in one. Chest drai ns were removed a mean of 8.5 days after operation. All patients were well without signs of infection 1-21 months later, and in no case was conversion to open operation necessary. Conclusion: Early thoracoscopi c debridement and drainage is a safe and effective alternative to open treatment of patients with pleural empyema in the fibrinopurulent or early organising phase.