Surgical treatment for chronic pleural empyema

Various surgical procedures have been developed in an attempt to alleviate the significant problems caused by chronic pleural empyema, The present stu dy evaluates our 11-year experience of employing a number of therapeutic ap proaches for chronic empyema, Between 1987 and 1997, 45 consecutive patient s underwent treatment for chronic empyema at our hospitals. They comprised 21 patients (47%) presenting with post-tuberculosis, 11 (24%) receiving can cer therapy including pulmonary resection, and 13 (29%) with postpneumonic empyema, Omentopexy, lung resection, and thoracoscopic surgery were perform ed in 10 (22%), 5 (11%), and 4 (9%) patients, respectively. Poor results of treatment were observed in two of the patients with post-tuberculous empye ma, and three of the patients treated for cancer died of recurrence, The ot her 40 patients remain symptom-free. An improvement in quality of postopera tive life was revealed by the exercise test rather than by static spirometr y, Optimal therapy for chronic empyema requires selection of the most appro priate first and staged procedures for each patient. Moreover, lung resecti on should be minimal. In a critical state, open thoracostomy must be perfor med as the first procedure, while omentopexy or thoracoplasty should be res tricted to selected cases. Dead space and minor air leakage may safely be l eft behind. A video-assisted procedure can be selected for postpneumonia em pyema.