Andrews thoracoplasty as a treatment of post-pneumonectomy empyema: Experience in 23 cases

Background. Andrew's thoracopleuroplasty has been described for treating tu berculous empyemas with bronchopleural fistulas. We report on its utilizati on for treating postpneumonectomy empyemas. Methods. During a 25 year period, 23 patients underwent thoracopleuroplasty for treating postpneumonectomy empyemas, after a period of drainage-irriga tion of the cavity. Seven patients presented with persistent bronchial fist ula at operation. After resection of the costal arches surrounding the infe cted cavity, the cavity was cleaned, and the external parietal plane was su tured to the mediastinal plane. Only drainage of the subscapular space was left in place. Results. Postoperative mortality was 4.3%. Postoperative recovery was simpl e in 17 cases, whereas a superficial abscess was evacuated in 3 cases. The procedure failed in 3 cases, which were treated by open thoracostomy (2), a nd by reenlargment of the thoracopleuroplasty (1). The sequelae were mainly a diminution of the shoulder mobility, especially when the first rib was r esected. Conclusions. Thoracopleuroplasty may safely treat postpneumonectomy empyema s, even those with bronchial fistulas. Most patients are definitively and r apidly cured with limited sequelae. (C) 1999 by The Society of Thoracic Sur geons.