RIGID THORASCOPIC DEBRIDEMENT AND CONTINUOUS PLEURAL IRRIGATION IN THE MANAGEMENT OF EMPYEMA

Study objective: To determine the role of rigid thoracoscopy and conti nuous pleural irrigation as an alternative to thoracotomy in criticall y ill patients. Design/setting/patients/interventions: Thirteen patien ts with empyema (one bilateral) underwent thorascopic decortication an d continuous postoperative irrigation with normal saline solution. Sev en patients required preoperative ventilator support. Measurements and results: Double-lumen intubation was utilized in only two cases. Empy emas were drained effectively in all patients, including nine patients in whom dense adhesions were encountered. Mean duration of irrigation was 3.5 +/- 0.5 days. There were no deaths. One patient developed a r ecurrent empyema 1 week after resolution of symptoms and underwent tho racotomy. Conclusions: Rigid thorascopic decortication is an effective method for treating empyemas and can be considered before thoracotomy . It can be performed in patients who might not be candidates for vide o-assisted thorascopic approaches owing to inability to tolerate one-l ung anesthesia or who have dense adhesions preventing lung collapse.