1
|
Bhalla AS, Jana M, Naranje P, Singh SK, Banday I. Challenges in Image-Guided Drainage of Infected Pleural Collections: A Review. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1734374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractInfected pleural fluid collections (IPFCs) commonly occur as a part of bacterial, fungal, or tubercular pneumonia or due to involvement of pleura through hematogenous route. Management requires early initiation of therapeutic drugs, as well as complete drainage of the fluid, to relieve patients’ symptoms and prevent pleural fibrosis. Image-guided drainage plays an important role in achieving these goals and improving outcomes. Intrapleural fibrinolytic therapy (IPFT) is also a vital component of the management. The concepts of image-guided drainage procedures, IPFT, and nonexpanding lung are discussed in this review.
Collapse
Affiliation(s)
- Ashu S. Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| | - Swish K. Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| | - Irshad Banday
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| |
Collapse
|
2
|
Jindal R, Nar AS, Mishra A, Singh RP, Aggarwal A, Bansal N. Video-assisted thoracoscopic surgery versus open thoracotomy in the management of empyema: A comparative study. J Minim Access Surg 2020; 17:470-478. [PMID: 33047681 PMCID: PMC8486060 DOI: 10.4103/jmas.jmas_249_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: With a rise in the incidence of thoracic empyema, surgical interventions also have evolved from the traditional open decortication to the current minimally invasive video-assisted thoracoscopic surgery (VATS). In this study, we determine the feasibility of VATS and also put the superiority of VATS over open thoracotomy (OT) to test. Subjects and Methods: Prospective single-centre comparative analysis of clinical outcome in 60 patients undergoing either VATS or OT for thoracic empyema was done between 1st September, 2014, and 1st November, 2018. Furthermore, another group of patients, who were converted intraoperatively from VATS to OT, was studied descriptively. Results: Nearly 75% of the patients were male with a mean age of 45.16 years. Every second patient had associated tuberculosis (TB), attributed to the endemicity of TB in India. When compared with OT, VATS had a shorter duration of surgery (268.15 vs. 178.33 min), chest tube drainage (11.70 vs. 6.13 days), post-operative hospital stay (13.56 vs. 7.42 days) and time to return to work (26.96 vs. 12.57 days). Post-operative pain and analgesic requirement were also significantly reduced in the VATS group (P < 0.0001). Conversion rate observed was 14.2%, the most common reason being the presence of dense adhesions. Conclusion: We conclude that VATS, a minimally invasive procedure with its substantial advantages over thoracotomy and better functional outcome, should be preferred whenever feasible to do so. Also if needed, conversion of VATS to the conventional open procedure, rather than a failure, is a wise surgical judgement.
Collapse
Affiliation(s)
- Rohit Jindal
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Amandeep Singh Nar
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Atul Mishra
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ravinder Pal Singh
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Aayushi Aggarwal
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Namita Bansal
- Research and Development Centre, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
3
|
Goryunova AV, Shevchenko YS, Goryunov AV. [Cogitum in children's neurology and psychiatry (experience in the practical use)]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:83-90. [PMID: 31532592 DOI: 10.17116/hirurgia20190715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors review current data on the role of the synthetic aspartic acid analogue N-acetyaspartate (NAA) in various biochemical metabolic reactions in the CNS. Its importance as a biomarker for neuropsychiatric disorders identified using magnetic resonance spectroscopy (MRS) is noted. The authors present their own results of the use of cogitum, a synthetic analogue of NAA, in children with the effects of traumatic brain injury, mental retardation, hyperactivity disorder and in the complex therapy of schizotypal disorder. Effects of cogitum on cognitive deficit, asthenia are evaluated. The neurotrophic effect of the drug, which specifically affects cognitive and asthenic disorders in these diseases, is shown.
Collapse
Affiliation(s)
- A V Goryunova
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - Yu S Shevchenko
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | | |
Collapse
|
4
|
ZHANG J, JU R, CHEN K, RUAN B, XING T. [Evaluation of the performance of a minimally invasive thoracic drainage tube in a rabbit model of hemothorax]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:647-651. [PMID: 29997085 PMCID: PMC6765714 DOI: 10.3969/j.issn.1673-4254.2018.06.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the performance of a minimally invasive thoracic drainage tube (14 F) made of polyurethane (PU) in a rabbit model of hemothorax in comparison with the conventional 28 F chest tube (CCT). METHODS Thirty New Zealand rabbits were divided into experimental chest tube (ECT) group (n=9), CCT group (n=6), and blood provider group (n=15). Blood samples (20 mL) collected from the blood providing rabbits were injected into the chest cavity of the rabbits in the other two groups, and the time taken for closed drainage of the thoracic cavity was recorded. The rabbits in ECT and CCT groups were subjected to blood injections (20 mL for each injection) into the chest cavity every 20 min for 5 times, and the volumes of blood drained by ECT and CCT were measured. Two hours later, the rabbits were sacrificed and the residual blood and blood clots in the chest cavities were observed. RESULTS Compared with CCT, the use of ECT significantly shortened the operation time (P < 0.05) and produced more effective blood drainage at 20 min and 40 min after the placement of the drainage tube (P < 0.05). No significant difference was found in the total blood volume drained between ECT and CCT groups, but the volume of residual blood in the thoracic cavity was significantly smaller in ECT group than in CCT group. No post-operative complications were found in the rabbits in ECT group while all the rabbits in CCT group had abutment pressure to the lung. CONCLUSION Compared to CCT, ECT is less invasive and allows more effective thoracic drainage with more convenient operation and reduced postoperative complications, suggesting its potential for use in closed thoracic drainage in single-port video-assisted thoracoscopic surgery (VATS) or in pediatric patients.
Collapse
Affiliation(s)
- Jiaqing ZHANG
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China南方医科大学珠江医院胸心外科,广东 广州 510280
| | - Ruihong JU
- Guangzhou Aier Eye Hospital, Guangzhou 510062, China广州爱尔眼科医院,广东 广州 510062
| | - Kuntang CHEN
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China南方医科大学珠江医院胸心外科,广东 广州 510280
| | - Baoqin RUAN
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China南方医科大学珠江医院胸心外科,广东 广州 510280
| | - Tingting XING
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China南方医科大学珠江医院胸心外科,广东 广州 510280
| |
Collapse
|
5
|
Petrella F, Sandri A, Rizzo S, Borri A, Galetta D, Gasparri R, Spaggiari L. Emergency drain for post pneumonectomy bronchopleural fistula: a drain placement technique based on the siphon principle. J Thorac Dis 2018; 10:468-471. [PMID: 29600080 DOI: 10.21037/jtd.2017.11.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Post pneumonectomy bronchopleural fistula (BPF) is a life-threatening complication requiring pleural cavity drainage to avoid acute mediastinal shift and contralateral aspiration pneumonia. Chest drain insertion in this situation may be technically difficult because of drastic anatomical changes such as mediastinal dislocation, diaphragm elevation and, sometimes, massive subcutaneous emphysema. In addition, the most important part of the pleural cavity to be drained is the costophrenic recess that is scarcely drained by a standard chest tube with its tip aiming high and upwards. We propose a safe, simple and effective technique based on the siphon principle to drain the lowest part of the pleural cavity.
Collapse
Affiliation(s)
- Francesco Petrella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Alberto Sandri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Stefania Rizzo
- Division of Radiology, European Institute of Oncology, Milan, Italy
| | - Alessandro Borri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
6
|
Perikleous P, Rathinam S, Waller DA. VATS and open chest surgery in diagnosis and treatment of benign pleural diseases. J Vis Surg 2017; 3:84. [PMID: 29078647 DOI: 10.21037/jovs.2017.05.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 11/06/2022]
Abstract
A negative pressure normally exists between the visceral and parietal pleurae in the lungs, which can act as vacuum for fluid, air and small particles from different parts of the body, allowing them to move into the pleural space and be retained in it, thus resulting to different manifestations of pleural disorders. A pleural effusion is the result of fluid collection between the parietal and visceral pleural surfaces. The most common cause in developed countries is congestive heart failure, followed by pneumonia and malignancy. It is highly important that a systematic approach is undertaken during the investigation of pleural effusions. Treatment should be based on the nature of the effusion and underlying condition, while undiagnosed patients should remain under surveillance. Pleural infection is a serious clinical condition which affects approximately 65,000 patients every year in the UK and can result in mortality in rates as high as 20%. The selection of treatment as well as timing of intervention remains a debatable issue among pulmonologists and thoracic surgeons. Surgical intervention aims to control sepsis, by facilitating evacuation of necrotic material from the pleural space, and obliterate the empyema cavity, by allowing the trapped lung to re-expand via peeling of the organised cortex from its visceral pleura. Thoracoscopic surgery offers the advantages of visual assessment of the pleural space and direct tissue sampling and it can be useful for the diagnosis of unknown pleural effusions and in the management of complicated collections. Open thoracotomy remains the gold standard, however with the advancement of thoracoscopic instruments and techniques, minimally invasive approaches provide comparable outcomes and have been taking over the management of benign pleural diseases.
Collapse
Affiliation(s)
- Periklis Perikleous
- Department of thoracic surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Sridhar Rathinam
- Department of thoracic surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - David A Waller
- Department of thoracic surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| |
Collapse
|
7
|
Migliore M, Borrata F, Nardini M, Criscione A, Calvo D, Gangemi M, Scalieri F. Awake uniportal video-assisted thoracic surgery for complications after pneumonectomy. Future Oncol 2016; 12:51-54. [PMID: 27744718 DOI: 10.2217/fon-2016-0362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since 1998, we started a clinical program for awake video-assisted thoracic surgery in our unit using four-step local anesthesia and sedation. Throughout the years, we experienced several difficult cases, three of them had complications postpneumonectomy. The aim of this paper is to report these three cases.
Collapse
Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Francesco Borrata
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Marco Nardini
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Alessandra Criscione
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Damiano Calvo
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Mariapia Gangemi
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| | - Francesco Scalieri
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Catania, Italy
| |
Collapse
|
8
|
Caruana EJ, Kadlec J, Iyer S, Mani A, Solli P, Scarci M. The Aquamantys(®) system improves haemostasis and pneumostasis in open decortication for thoracic empyema. J Thorac Dis 2016; 8:1540-5. [PMID: 27499941 DOI: 10.21037/jtd.2016.06.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Decortication for thoracic empyema is associated with significant blood loss and prolonged postoperative air leak. We sought to assess the potential application of an irrigated-tip radiofrequency (RF) sealing device, in an attempt to reduce this morbidity. METHODS Data for all patients undergoing open decortication (OD) for stage II thoracic empyema, using either conventional approach or facilitated by use of the Aquamantys(®) device, at a single thoracic surgical unit between April 2010 and July 2014, were retrospectively analysed. Unpaired t-test and Fisher's exact test were used for statistical analysis. RESULTS Thirty-three patients, aged 54±15 years (mean ± SD), and with a Charlson comorbidity index of 2.5±1.9 were included. Preoperative and intraoperative characteristics, including surgical time, were similar in the conventional and Aquamantys(®) groups. Patients in the Aquamantys group were less likely to require red cell transfusion (9/22 vs. 10/11 patients, P=0.024) and received lower volume transfusions [0.0 (2.0) vs. 3.0 (1.6) units (median, IQR), P<0.0001]; chest drain duration was shorter [3.0 (1.0) vs. 6.5 (6.8) days, P=0.006], as was length of postoperative hospital stay [6.0 (8.7) vs. 10.0 (4.6) days, P=0.031]. There was no demonstrable difference in mortality. CONCLUSIONS Our data indicates that the use of irrigated tip RF ablation is safe and effective in improving pneumostasis and haemostasis in decortication for thoracic empyema; and that this translates to morbidity and logistical benefit.
Collapse
Affiliation(s)
| | - Jakub Kadlec
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | | | | |
Collapse
|
9
|
Welter S, Cheufou D, Darwiche K, Stamatis G. [Tracheal injuries, fistulae from bronchial stump and bronchial anastomoses and recurrent laryngeal nerve paralysis : management of complications in thoracic surgery]. Chirurg 2016; 86:410-8. [PMID: 25794450 DOI: 10.1007/s00104-014-2862-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Complications cannot always be avoided and their treatment is an integral component of a high quality medical treatment. Complications of the central airways are rare but necessitate supportive treatment by an experienced thoracic surgeon. OBJECTIVE The reader should become acquainted with measures to prevent complications, to recognize and treat complications early and should understand the necessity for an interdisciplinary approach. MATERIAL AND METHODS A selective literature research was supplemented by personal experiences and complemented with prospectively collected photographs. RESULTS There are risk constellations for the appearance of all the mentioned complications which the surgeon needs to know in order to be able to take measures for early detection of complications. Iatrogenic tracheal injuries and bronchial stump fistulae are rare (< 5 %) whereas recurrent laryngeal nerve palsy after left-sided pneumonectomy occurs in up to 30 % of cases. DISCUSSION After the occurrence of complications at the latest, it is very important to include experienced thoracic surgeons and other specialists when necessary to protect the patient from further damage.
Collapse
Affiliation(s)
- S Welter
- Abteilung Thoraxchirurgie und thorakale Endoskopie, Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen, Tüschener Weg 40, 45239, Essen, Deutschland,
| | | | | | | |
Collapse
|
10
|
Scarci M, Abah U, Solli P, Page A, Waller D, van Schil P, Melfi F, Schmid RA, Athanassiadi K, Sousa Uva M, Cardillo G. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg 2015; 48:642-53. [PMID: 26254467 DOI: 10.1093/ejcts/ezv272] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/15/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marco Scarci
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Udo Abah
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Piergiorgio Solli
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Aravinda Page
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - David Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Franca Melfi
- Department of Cardiothoracic Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ralph A Schmid
- Division of General Thoracic Surgery, Berne University Hospital, Berne, Switzerland
| | | | - Miguel Sousa Uva
- Unit of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon, Portugal
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Az. Osped. S. Camillo Forlanini, Carlo Forlanini Hospital, Rome, Italy
| |
Collapse
|
11
|
Borges N, Saha S. Thoracoplasty for Postpneumonectomy Empyema Associated with Bronchopleural Fistula: A Case Series. Int J Angiol 2015; 24:151-4. [PMID: 26060389 DOI: 10.1055/s-0034-1370886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Thoracoplasty is a historical procedure, initially devised for the treatment of refractory tuberculous empyema. Advances in medical treatments have nearly eliminated the need for this surgical procedure in pulmonary tuberculosis and it is rarely performed or taught in modern day surgical practice. However, few indications still exist, most prominently, in the treatment of postpneumonectomy refractory empyema often but not always associated with a bronchopleural fistula. In this case report, we present two cases of postpneumonectomy refractory empyema treated by thoracoplasty with long-term follow-up.
Collapse
Affiliation(s)
- Nyal Borges
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sibu Saha
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
12
|
Chen B, Zhang J, Ye Z, Ye M, Ma D, Wang C, Zhu C. Outcomes of Video-Assisted Thoracic Surgical Decortication in 274 Patients with Tuberculous Empyema. Ann Thorac Cardiovasc Surg 2015; 21:223-8. [PMID: 25818121 DOI: 10.5761/atcs.oa.14-00185] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The present work aimed to retrospectively assess the outcomes associated with decortication by video-assisted thoracic surgery (VATS) in patients with tuberculous empyema. METHODS Patients (n = 274) who underwent decortication by VATS for surgical management of pleural empyema between January 2000 to 2010 were included. Pre-, intra-, and postoperative characteristics were observed for all patients, which were followed up for 12 months to evaluate surgical outcomes such as postoperative complications and disease recurrence. RESULTS No patients required conversion to thoracotomy, and no death or postoperative bleeding was reported. The mean operation time was 104.5 ± 20.4 min, with 271.5 ± 41.3 ml intraoperative blood loss and median length of hospital stay of 7.2 ± 3 .4 days. Of the 274 patients, 262 were followed up for 12 months; 26 (9.9%) patients showed complications, including incomplete lung re-expansion (11 patients) and persistent air leak (6 patients). While early disease recurrence was observed in 3 (1.1%) patients after surgery, late recurrence was reported for 6 (2.3%) individuals. Interestingly, the complication rate was much higher in patients with chronic empyema (15/34, 44.1%) than in subjects with acute empyema (11/228, 4.8%). CONCLUSIONS Decortication by VATS decreases postsurgical complications, and results in decreased disease recurrence. This study demonstrated improved outcomes by decortication by VATS, even in patients with stage III tuberculous empyema.
Collapse
Affiliation(s)
- Baofu Chen
- Taizhou Hospital of Zhejiang Province, Linhai, China
| | | | | | | | | | | | | |
Collapse
|
13
|
Botianu AM, Botianu PVH. Modified thoraco-mediastinal plication (Andrews thoracoplasty) for post-pneumonectomy empyema: experience with 30 consecutive cases. Interact Cardiovasc Thorac Surg 2012; 16:173-7; discussion 177-8. [PMID: 23129718 DOI: 10.1093/icvts/ivs437] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of our study is to evaluate the results of thoraco-mediastinal plication for the treatment of post-pneumonectomy empyema. METHODS From 1 January 1985 to 1 January 2011, 30 patients underwent post-pneumonectomy empyema through a modified thoraco-mediastinal plication procedure (Andrews thoracoplasty). Indications for pneumonectomy included cancer (25 cases), tuberculosis (3 cases), and bronchiectasis (two cases). Rib resection was performed according to the topography of the cavity, ranging between 5 and 10. Neighbourhood muscle flaps were used in 22 cases but extensive mobilization was performed only in our last 4 cases, the aim of the procedure being the complete obliteration of the infected space. Bronchial fistula was present in 14 cases and was closed and reinforced with the use of flaps (intercostal 12 cases, serratus 1 case, and omentum 1 case). RESULTS Overall mortality was 6.7% (2 cases); 2 patients (6.7%) presented with recurrence of the empyema requiring an open-window procedure and another patient (3.3%) presented with local tumoral recurrence. Intensive care unit hospitalization ranged between 1 and 14 days, with a median of 4 days, while overall postoperative hospitalization ranged between 23 and 52 days with a median of 32 days, the patients being discharged with healed wounds. Kaplan-Meier analysis of the oncologic patients showed a median survival of 41 months from thoraco-mediastinal plication. The presence of bronchial fistula had no statistically significant impact on the immediate outcome (mortality, need for postoperative prolonged mechanical ventilation, intensive care and overall postoperative hospitalization, P > 0.05 for all the parameters). CONCLUSIONS Space-filling procedures are a valuable option for treating post-pneumonectomy empyema. The major advantages are the complete obliteration of the infected space and the quick healing from a single procedure; the major disadvantages are the magnitude of the procedure (with associated mortality and morbidity) and the permanent chest mutilation. Several technical details may improve the results and reduce the chest wall mutilation.
Collapse
|
14
|
Hysi I, Rousse N, Claret A, Bellier J, Pinçon C, Wallet F, Akkad R, Porte H. Open window thoracostomy and thoracoplasty to manage 90 postpneumonectomy empyemas. Ann Thorac Surg 2011; 92:1833-9. [PMID: 21955574 DOI: 10.1016/j.athoracsur.2011.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 07/03/2011] [Accepted: 07/11/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Postpneumonectomy empyema (PPE) is a serious complication. The treatment options are similar to the management of any abscess, with drainage, ideally open, often of critical importance. After infection control, many techniques for space obliteration have been described. This study summarizes a 10-year experience in the management of PPE in our center. METHODS From 2000 to 2010, 90 patients (83 men) with PPE were treated. Median follow-up was 5.3 years. Once the diagnosis of empyema was confirmed, chest drainage was performed through open window thoracostomy (OWT), with ensuing extramusculoperiosteal thoracoplasties if healthy tissue was present. RESULTS Pneumonectomy was performed in 72 patients with lung cancer. Mortality after PPE was 2.2%. OWT achieved infection control in 89 patients. Seven OWT spontaneously healed, and 24 were never closed. The remaining 59 patients with OWT underwent thoracoplasty. Mortality after thoracoplasty was 5%. Empyema recurred in 3 patients. Overall success rate of PPE control after pleural obliteration was 91.5%. CONCLUSIONS Thoracoplasty is a reliable filling procedure. It has a significantly higher success rate and a lower mortality rate than the other techniques. We believe that this procedure has a part to play in the future management of PPE.
Collapse
Affiliation(s)
- Ilir Hysi
- Department of Thoracic Surgery, "Albert Calmette" Hospital, Lille, France.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Cafarotti S, Porziella V, Margaritora S, Granone P. eComment: Re: What is the best treatment of postpneumonectomy empyema? Interact Cardiovasc Thorac Surg 2011; 12:264. [PMID: 21257955 DOI: 10.1510/icvts.2010.254706a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Stefano Cafarotti
- Department of Thoracic Surgery, Catholic University, 00168 Rome, Italy
| | | | | | | |
Collapse
|