Video-assisted thoracoscopic access in pleural empyema compared with mere chest tube drainage

Video-assisted thoracoscopic (VAT) debridement is gaining importance in the fibrino-purulent phase of empyema thoracis. However, evaluation of this ac cess compared with mere chest tube drainage or thoracotomy remains unsatisf actory. A total of 356 parapneumonic empyemas from 1986 to 1997 were retros pectively analyzed concerning the results after primary treatment (chest tu be 225, thoracotomy 80, VAT 51). The three groups did not differ significan tly for gender and associated diseases. Median age of the chest tube draina ge group (54 years) was higher than for thoracotomy (43.5 years) or VAT (39 years). Median duration of chest tube treatment after thoracotomy (7 days) was shorter than after VAT (13 days) or chest tube drainage (20 days) (P < 0.0001). The more invasive procedures were also superior to the lesser inv asive treatment concerning duration of postoperative hospitalization, recur rence rate and treatment failures. In spite of its better results thoracoto my will be pushed back by VAT in the treatment of empyema thoracis. Accepta nce of VAT is reflect-ed in rising numbers of admissions. Based on these re trospective results we are planning a prospective multicenter trial to eval uate the indication for VAT in empyema thoracis.