Developments in surgical treatment of pleural empiema
Journal
Macedonian Journal of Anaesthesia
Date Issued
2023-12
Author(s)
Cholanceski R
Ferati I
DOI
10.55302/MJA2373064k
Abstract
Thoracic empyema is the accumulation of pus within the pleural cavity. The most frequent
cause is direct contiguous spread of infection, the most frequent from lung infection. Current
management of empyema is based on local empirical practice as there is no consensus on an
optimal regimen. It is estimated that 40% (7-57%) of pneumonia, results with parapneumonic
effusion, out of which 10% develop empyema of pleural space.
Treatment covers antibiotics, pleural drainage, pleural drainage and use of fibrinolytics,
VATS early debridement, VATS decortication, open decortication, open pleural window and
thoracoplasty. The choice of adequate treatment is according to stage of empyema: I (exudative
stage) - thoracic drainage, II (fibrinopurulent stage) - thoracic drainage with fibrinolytics and
VATS debridement or VATS early decortication and for III (empyema in organization stage) -
VATS or open decortication or later thoracoplasty. Early VATS debridement effectively manages
simple parapneumonic effusions. VATS decortication has efficacy for managing early-stage
empyema.
In the past (2011-15) period 234 patients with empyema were treated, out of which 124
(52.99%) of empyema were treated with pleural drainage, 105 (44.87%) were treated with open
decortication and 5 (2.14%) with thoracoplasty.
In the last 6 months of 2023, 21 patients were treated, 19 (90.5%) male and 2 (9.5%) female.
Unfortunately, in the last 6 months only 5 (23.8%) of the patients were treated only with pleural
drainage, 4 (19%) patients were treated with VATS debridement or early decortication and 12
(57.14%) patients were treated with pleural drainage that finished with open decortication. This
situation suggests that, unfortunately, empyema was detected in advanced stage that needed
aggressive surgical treatment.
Early detection of parapneumonic effusion and treatment in this stage will prevent development
of empyema and need of aggressive treatment.
cause is direct contiguous spread of infection, the most frequent from lung infection. Current
management of empyema is based on local empirical practice as there is no consensus on an
optimal regimen. It is estimated that 40% (7-57%) of pneumonia, results with parapneumonic
effusion, out of which 10% develop empyema of pleural space.
Treatment covers antibiotics, pleural drainage, pleural drainage and use of fibrinolytics,
VATS early debridement, VATS decortication, open decortication, open pleural window and
thoracoplasty. The choice of adequate treatment is according to stage of empyema: I (exudative
stage) - thoracic drainage, II (fibrinopurulent stage) - thoracic drainage with fibrinolytics and
VATS debridement or VATS early decortication and for III (empyema in organization stage) -
VATS or open decortication or later thoracoplasty. Early VATS debridement effectively manages
simple parapneumonic effusions. VATS decortication has efficacy for managing early-stage
empyema.
In the past (2011-15) period 234 patients with empyema were treated, out of which 124
(52.99%) of empyema were treated with pleural drainage, 105 (44.87%) were treated with open
decortication and 5 (2.14%) with thoracoplasty.
In the last 6 months of 2023, 21 patients were treated, 19 (90.5%) male and 2 (9.5%) female.
Unfortunately, in the last 6 months only 5 (23.8%) of the patients were treated only with pleural
drainage, 4 (19%) patients were treated with VATS debridement or early decortication and 12
(57.14%) patients were treated with pleural drainage that finished with open decortication. This
situation suggests that, unfortunately, empyema was detected in advanced stage that needed
aggressive surgical treatment.
Early detection of parapneumonic effusion and treatment in this stage will prevent development
of empyema and need of aggressive treatment.