Video-assisted thoracoscopy in the treatment of pleural empyema: Stage-based management and outcome

Objective: Despite modern diagnostic methods and appropriate treatment, ple ural empyema remains a serious problem. Our purpose was to assess the feasi bility and efficacy of the video-assisted thoracoscopic surgery in the mana gement of nontuberculous fibrinopurulent pleural empyema after chest tube d rainage treatment had failed to achieve the proper results. Methods: We pre sent a prospective selected single institution series including 45 patients with pleural empyema who underwent an operation between March 1993 and Dec ember 1996, Mean preoperative length of conservative management was 37 days (range, 8-82 days). All patients were assessed by chest computed tomograph y and ultrasonography and underwent video-assisted thoracoscopic debridemen t of the empyema and postoperative irrigation of the pleural cavity, Result s: In 37 patients (82%), video-assisted thoracoscopic debridement was succe ssful. In 8 cases, decortication by standard thoracotomy was necessary. The re were no complications during video-assisted thoracic operations. The mea n duration of chest tube drainage was 7.1 days (range, 4-140 days), At foll ow-up (n = 35) with pulmonary function tests, 86% of the patients treated b y video-assisted thoracic operation showed normal values: 14% had a moderat e obstruction and restriction without impairment of exercise capacity, and no relapse of empyema was observed. Conclusions: Video-assisted thoracoscop ic debridement represents a suitable treatment for fibrinopurulent empyema when chest tube drainage and fibrinolytics have failed to achieve the prope r results, In an early organizing phase, indication for video-assisted thor acic operation should be considered in due time to ensure a definitive ther apy with a minimally invasive intervention. For pleural empyema in a later organizing phase, full thoracotomy with decortication remains the treatment of choice.