Video-assisted thoracoscopic surgery in the management of loculated empyema

Background: Fibropurulent empyema (stage II of Light) does not respond to a ntibiotic therapy and simple drainage. If the condition is inadequately tre ated, restrictive pulmonary deficit develops, necessitating thoracotomy and decortication. We report our experience with the videoscopic management of stage II and limited stage III disease. Methods: Ten consecutive patients underwent videoscopic debridement of fibr opurulent empyema; three of them required removal of limited visceral and p arietal rind. Results: The mean operating time was 42 +/- 8.1 min. Postoperative pyrexia and leucocytosis settled within 4.2 +/- 2.1 days and 13.1 +/- 3.2 days, res pectively. Intercostal chest tubes were removed by 4.5 +/- 1.0 days, The me an fall in hematocrit following surgery was 4.9%, Parenteral analgesics wer e required for 1.0 +/- 0.5 days and oral analgesics for 3 +/- 1.6 days. The mean postoperative stay was 11 +/- 8.1 days. No patient required any furth er intervention. Conclusions: Videoscopic debridement of empyema produces excellent results, with minimal patient morbidity and a short hospital stay. We recommend it as the preferred method for first-line management of fibropurulent (stage I I) empyema.