DECORTICATION IS A VALUABLE OPTION FOR LATE EMPYEMA AFTER COLLAPSE THERAPY

Background. Infection of previous collapse therapy spaces may raise ch allenging problems. This study evaluated a conservative surgical appro ach based on decortication. Methods. Since 1979, 28 patients (mean age , 60 +/- 6 years) have presented at an average of 37 +/- 7 years after artificial pneumothorax for tuberculosis. Diagnosis of empyema was ma de on follow-up in 12 patients and on symptoms in 16 patients. Mean vi tal capacity was 66% +/- 16% of normal. Microorganisms were isolated i n 13 patients (Aspergillus fumigatus in 5, Mycobacterium turberculosis in 4, anaerobes in 4). Decortication was made in 24 patients, associa ted with thoracoplasty in 4, and with partial lung resection in 2 pati ents. Thoracoplasty alone was performed in 2 patients, and 2 patients underwent an extrapleural pneumonectomy. Results. Both extrapleural pn eumonectomies were complicated with empyema requiring thoracoplasty, r esulting in one postoperative death. Operative mortality after decorti cation was nil. Mean intraoperative blood loss during decortication wa s 1,830 +/- 1,310 mL. All patients were extubated within 24 hours, exc ept 1 patient who was ventilator-dependent preoperatively. Prolonged a ir leaks were common (mean duration of drainage, 16 +/- 11 days), but ultimately sealed. Existence of symptoms was predictive of prolonged a ir leaks (p < 0.01). Conclusions. We conclude that decortication may p rovide a one-stage cure avoiding the hazards of extrapleural pneumonec tomy; the nonfunctioning remaining lung may resolve the space problem.