Eastern Cardiothoracic Surgical Society

Video-Assisted Thoracoscopic Decortication for the Management of Late Stage Pleural Empyema, Is It Easible?
Rawan K. Alsultan, Waseem Hajjar, Waad Alwgait, Hanoof Alkhalaf, King Saud University, Riyadh, Saudi Arabia.


Objective: The aim was to estimate the effectiveness of thoracoscopic debridement in the advanced stages of pleural empyema.

Methods: All patients with pyogenic empyema (stage II & Stage III) in our Hospital, (admitted from January 2009 to December 2013) who did not respond to chest tube/pigtail drainage and/or antibiotic therapy were treated with VATSD and/or open thoracotomy. Prospective evaluation was carried out and the effect of this technique on perioperative outcomes was appraised to evaluate our technical learning with the passage of time and experience with VATS for late stage empyema management.

Results: Out of total 63 patients, 26 had stage II empyema and 37 had stage III empyema. VATSD was employed on all empyema patients admitted in our Hospital. VATSD was successful in all patients with stage II empyema. Twenty-five patients (67.6%) with stage III empyema completed VATSD successfully. However, only 12 cases (32.4%) required conversions to open (Thoracotomy) drainage (OD). The median hospital stay for stage III VATSD required 9.65 4.1 days. Whereas, patients who underwent open thoracotomy took longer time (21.82 16.35 days). Similarly, stage III VATSD and stage III open surgery cases showed significance difference among chest tube duration (7.84 3.33 days for VATS and 15.92 8.2 days for open thoracotomy).

Conclusions: VATSD facilitates the management of fibrinopurulent, organized pyogenic pleural empyema with less postoperative discomfort, reduced hospitalization, and have fewer postoperative complications. VATSD can be an effective, safe as first option for patients with stage II pleural empyema, and feasible in most patients with stage III pleural empyema.