Benefits of early aggressive management of empyema thoracis

ANZ J Surg. 2006 Mar;76(3):120-2. doi: 10.1111/j.1445-2197.2006.03666.x.


Background: The end-target of the management of thoracic empyema is to obtain early rehabilitation by re-expansion of the trapped lung resulting from intrapleural infected material. Our aim was to shorten the hospitalization time and to prevent a possible thoracotomy by using video-assisted thoracoscopy initially.

Methods: Seventy patients with parapneumonic empyema were prospectively studied between January 1997 and June 2004. The patients were randomly divided into two groups. In group I (n = 35 patients), a chest tube was inserted into the patients after pleural content was evacuated and fibrins were debrided using video-assisted thoracoscopy. In group II (n = 35 patients), tube thoracostomy was carried out without using a video-assisted thoracoscope. Both groups were compared in terms of hospitalization time, open surgery for decortication and complications.

Results: There was no statistically significant difference between the groups from the point of view of age and sex (P > 0.05). In group I, 17.1% of the patients underwent open decortication, whereas in group II, 37.1% of the patients underwent the same procedure (P < 0.05). Whereas average hospital stay in group I was 8.3 days (range, 7-11 days), it was 12.8 days in group II (range, 10-18 days; P < 0.05). There was one bronchopleural fistula in group I, and there was one bronchopleural fistula and one death in group II.

Conclusion: Video-assisted thoracoscopic evacuation and chest tube insertion in situ is a new therapeutic approach for pleural empyema that shortens hospital stay and reduces the necessity of open decortication.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Empyema, Pleural / diagnostic imaging
  • Empyema, Pleural / microbiology
  • Empyema, Pleural / surgery*
  • Female
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Prospective Studies
  • Thoracic Surgery, Video-Assisted*
  • Tomography, X-Ray Computed
  • Treatment Outcome