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 study evaluates our 11-year experience of employing a number of therapeutic approaches for chronic empyema. Between 1987 and 1997, 45 consecutive patient...

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Bibliographic Details
Published in:Surgery today (Tokyo, Japan) Japan), 2000-01, Vol.30 (6), p.506-510
Main Authors: Okada, M, Tsubota, N, Yoshimura, M, Miyamoto, Y, Yamagishi, H, Satake, S
Format: Article
Language:English
Subjects:
Adult
Aged
Algorithms
Case-Control Studies
Chronic Disease
Empyema, Pleural - surgery
Female
Humans
Male
Middle Aged
Omentum - surgery
Pneumonectomy
Quality of Life
Thoracoplasty
Thoracoscopy
Thoracostomy
Treatment Outcome
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Summary:Various surgical procedures have been developed in an attempt to alleviate the significant problems caused by chronic pleural empyema. The present study evaluates our 11-year experience of employing a number of therapeutic approaches for chronic empyema. Between 1987 and 1997, 45 consecutive patients underwent treatment for chronic empyema at our hospitals. They comprised 21 patients (47%) presenting with post-tuberculosis, 11 (24%) receiving cancer therapy including pulmonary resection, and 13 (29%) with postpneumonic empyema. Omentopexy, lung resection, and thoracoscopic surgery were performed in 10 (22%), 5 (11%), and 4 (9%) patients, respectively. Poor results of treatment were observed in two of the patients with post-tuberculous empyema, and three of the patients treated for cancer died of recurrence. The other 40 patients remain symptom-free. An improvement in quality of postoperative life was revealed by the exercise test rather than by static spirometry. Optimal therapy for chronic empyema requires selection of the most appropriate first and staged procedures for each patient. Moreover, lung resection should be minimal. In a critical state, open thoracostomy must be performed as the first procedure, while omentopexy or thoracoplasty should be restricted to selected cases. Dead space and minor air leakage may safely be left behind. A video-assisted procedure can be selected for postpneumonia empyema.
ISSN:0941-1291
1436-2813
DOI:10.1007/s005950070116