Surgical treatment of pleural empyema – our results
Journal
Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki)
Date Issued
2017-09-01
Author(s)
I. Dzikovski
N. Toleska-Dimitrovska
Sanja Petrusevska-Marinkovik
Abstract
Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce morbidity,
mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need
to use extensive surgery - decortications or thoracoplasty. Early recognition of the parapneumonic
effusion and the adequate treatment with thoracentesis or pleural drainage, which is minimally
invasive, is possible not to prograde the process and not to become empyema.
Aim: To analyze the results of the surgical treatment in patients with empyema treated at Clinic
for thoracic surgery.
Material and methods: In the retrospective study we analyzed 234 patients with empyema which
were treated at the Clinic for Thoracic Surgery in 5 year period (2011-2015). The mean age of the
patients was 51.94 years. They were treated with pleural drainage, decortications or thoracoplasty.
Results: With pleural drainage were treated 165/234 (70.51%) patients, of which successfully were
finished 124/165 (75.15%), but 41/165 (24.85%) were indicated after the decortications. A total
of 108/234 (46.15%) were treated with decortications from which, primary decortications were
indicated in 67/234 (28.63%) patients. 5/234 (2.14%) patients were treated with thoracoplasty – 3
of the patients with decortications and 2 with primary indicated thoracoplasty according to the local
findings, long term untreated empyema and bad general condition. The Mean hospitalization was
17.4 days, of which 13.4 days after surgery. In the group with primary drainage it was detected
a lethal outcome in 7/124 (5.64%) patients, 5/105 (4.76%) in the group with decortications and
2/5 (40%) in the group with thoracoplasty.
Conclusion: Early detection of the parapneumonic effusion and the adequate treatment will prevent
the appearance of empyema. If the empyema is detected it is necessary as early as possible
to start the treatment with minimally invasive pleural drainage. In earlier stages it is possible to
use less invasive decortications, using VATS than the open thoracotomy decortication which is
more extensive surgical intervention.
mortality and duration of hospital stay. Unfortunately, advanced stages of empyema need
to use extensive surgery - decortications or thoracoplasty. Early recognition of the parapneumonic
effusion and the adequate treatment with thoracentesis or pleural drainage, which is minimally
invasive, is possible not to prograde the process and not to become empyema.
Aim: To analyze the results of the surgical treatment in patients with empyema treated at Clinic
for thoracic surgery.
Material and methods: In the retrospective study we analyzed 234 patients with empyema which
were treated at the Clinic for Thoracic Surgery in 5 year period (2011-2015). The mean age of the
patients was 51.94 years. They were treated with pleural drainage, decortications or thoracoplasty.
Results: With pleural drainage were treated 165/234 (70.51%) patients, of which successfully were
finished 124/165 (75.15%), but 41/165 (24.85%) were indicated after the decortications. A total
of 108/234 (46.15%) were treated with decortications from which, primary decortications were
indicated in 67/234 (28.63%) patients. 5/234 (2.14%) patients were treated with thoracoplasty – 3
of the patients with decortications and 2 with primary indicated thoracoplasty according to the local
findings, long term untreated empyema and bad general condition. The Mean hospitalization was
17.4 days, of which 13.4 days after surgery. In the group with primary drainage it was detected
a lethal outcome in 7/124 (5.64%) patients, 5/105 (4.76%) in the group with decortications and
2/5 (40%) in the group with thoracoplasty.
Conclusion: Early detection of the parapneumonic effusion and the adequate treatment will prevent
the appearance of empyema. If the empyema is detected it is necessary as early as possible
to start the treatment with minimally invasive pleural drainage. In earlier stages it is possible to
use less invasive decortications, using VATS than the open thoracotomy decortication which is
more extensive surgical intervention.
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