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VIDEO-ASSISTED THORACOSCOPY AS A STANDARD TREATMENT IN PARAPNEUMONIC EMPYEMAS

Klinikum Bremen-Ost, Bremen, Germany

PURPOSE: Para pneumonic empyma is a life threatening disease that needs a primary treatment with high cure rate and efficacy.

METHODS: All our patients who diagnosed to have pleura empyema had a pre-operative computed tomography CT scan of the chest before they managed by surgical intervention in terms of video-assisted thoracoscopy (VATS). The type of the procedure used in the treatment correlated with stage of empyema. In all patients the treatment includes intrapleural pus evacuation, surgical debreidment of the thick fibrinous loculations and post-operative once daily irrigation by 1 litre lactated Ringer's solution for 1 week. In stage II patients sometimes decortications of the visceral pleura was necessary where as decortications of the visceral and parietal pleurae is the method of choice in the treatment of stage III. The irrigation is discontinued and the chest tubes removed after 3 negative plural fluid cultures that are performed from the 8th till 10th post operative day. Antibiotics were used only if there is a CT scan evidence of pneumonia.

RESULTS: From 2003 till 2006, one hundred ninety five empyema patients were operated upon. In stage I there were 17 patients who had a therapy success rate of 87.5 % and an average hospital stay of 22 days. 160 patients were found to have stage II disease and the success rate of treatment was 70.6% and an average hospitalisation of 23days where as in stage III were 87.5% and 26 days respectively. In stage II subgroup 35 patients underwent a second revision by thoracoscopy after which all of them cured.4 open thoracotomy revisions were done in stage III group. Thirty three patients (16 from the revision group) died due sepsis and Multi organ failure syndrome (MOFS).

CONCLUSION: VATS is a feasible, effective method to treat all empyema patients in different stages.

CLINICAL IMPLICATIONS: In our centre we recommend VATS procedure primarily for all empyema patients.

DISCLOSURE: Erich Hecker, No Financial Disclosure Information; No Product/Research Disclosure Information