Current indications and results of pulmonary decortication for nontuberculous chronic empyema.

Pulmonary decortication for nontuberculous chronic empyema has become a rar e operation, whose indications and results are now rarely analysed and disc ussed. The authors report a series of 40 consecutive decortications perform ed over a period of 15 years. Patients. 40 patients treated by pulmonary de cortication over 15 years for nontuberculous chronic empyema secondary to p neumonia (27 cases; 2/3 of cases), post-traumatic haemothorax (5 cases), ia trogenic infection after pleural tap (5 cases) and septicaemia (3 cases). C hronic empyema had been present for an average of 6 months (1 to 60 months) . Decortication was performed for drainage of persistent pleural suppuratio n in 22 cases and to release the encysted lung in 18 cases. Decortication, always comprising parietal pleural stripping and visceral decortication, la sted an average of 3 hours (2 to 8 hours), and was accompanied by mean blee ding of 1 litre (of 200 ml to 3.41). Results: 27 patients (67 %) had an une ventful postoperative course, with drainage for 6 days and a mean hospital stay of 13 days. 13 patients (33 %) developed various complications, mainly re-expansion defects (10 cases), responsible for pyothorax in 3 cases, 3 o f which required secondary drainage. One patient died from intestinal obstr uction in a context of peritoneal carcinomatosis (operative mortality: 2.5 %). 25 patients were reviewed with a mean follow-up of 54 months, with comp lete pulmonary re-expansion in 23 cases (92 %) and a residual pouch in 2 ca ses. Vital capacity (VC) was evaluated in 8 patients, with a mean improveme nt of 40% ( 15 to 66%) in 6 patients, stable VC in one patient, and a 25 % reduction in the last patient, a smoker and with chronic bronchitis. Conclu sion : Pulmonary decortication is an effective, but relatively major operat ion to treat chronic encysted empyema. Encystment must be presented by effe ctive drainage of empyema, now facilitated by the possibility of early vide othoracoscopic pleural debridement.