Thoracic empyema remains a challenge in medical and surgical management. Morbidity and mortality are still significant following open surgical drainage, due to the extent of the procedure. Thoracoscopy has provided a less invasive and effective modality for the surgical management of empyema.
Two database of patients who had undergone Thoracoscopy by one thoracic surgeon at two private community hospitals between June 1992 and June 2003 was analyzed as to age, sex and side of occurrence of empyema including comorbidities and bacteriological findings. Computerizedaxial tomography of the chest was done in each patient preoperatively. Routine cultures and sensitivities were obtained in all cases as well as cultures for TB and fungus. End results were compiled with clinical evaluation, Chest X-Rays and wound status.
Two hundred twenty eight thoracoscopic procedures were performed by a single operator. From these twenty six (11.4%) were done for treatment of empyema. General Endotracheal anesthesia was used in all, and three ports were placed according to the location of the effusion. A 10mm. zero degree angle scope was utilized for visualization of the cavity. The ages were from 17 to 90 years. Seventeen were males (65.3%) and in sixteen (61.5%) the empyema occurred on the left side. There was only one death and was in a 90-year-old patient with severe COPD (3.84%). There were two tuberculous empyemas, but in many the cultures were negative for TB or fungus or other bacteria as a result of the previous antibiotic therapy. (See below for the organisms cultured).
Extensive debridment was feasible in all patients breaking loculations which are responsible for re-accumulation of fluid following simple tube thoracostomy. Partial decortication was possible in most of them. Chest tube drainage was used post-operatively. One or two chest tubes were utilized with an average time of drainage of 10 days.
Minimal impairment of pulmonary mechanics with VATS as compared to formal thoracotomy allow for a more quickly recovery with reduced morbidity.
C.M. Chavez, None.