Thoracoscopic treatment of pleural empyema

From August 1991 to May 1997 46 patients with pleural empyema in the fibrin opurulent phase underwent thoracoscopic surgery. There were 36 men and 10 w omen with an average age of 47 years ranging from 18 to 84. The average ope rating time was 77 minutes. When only one thoracostomy drain was inserted. the drainage time was 8.5 days, if two or three drainage tubes, were used i t was 10.5 days. The average hospital stay was 18.1 day (range from 7 to 45 ). We observed ten complications. Four operations had to be converted to an open procedure because of massive thickening and fibrosis of the pleura. T hree patients did not tolerate one lung ventilation, once the lung did not collapse due to technical reasons and in one patient each we observed a lac eration of the parenchyma and bleeding from the parenchyma. In both cases t he problem was dealt with thoracoscopically. We observed a recurrent pleura l empyema in four patients which occurred between the 28th and 77th postope rative day. In summary, thoracoscopic surgery in patients with pleural empy ema in the fibrinopurulent phase is an effective and well tolerated alterna tive to open thoracotomy.