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Eur J Cardiothorac Surg 2002;21:644-648
© 2002 Elsevier Science NL

Prevention of recurrent empyema after pneumonectomy for chronic infection

Department of Surgery, Division of Thoracic Surgery, University Hospital, 8091 Zurich, Switzerland

Received 19 September 2001; received in revised form 7 January 2002; accepted 10 January 2002.

* Corresponding author. Tel.: +41-1-255-8802; fax: +41-1-255-8805
e-mail: walter.weder{at}chi.usz.ch

Objectives: Pneumonectomy in chronic pulmonary infection with empyema is associated with a high mortality rate and an increased risk of recurrent empyema. The surgical resection is technically demanding, and successful management continues to be a challenge. Methods: We evaluated a concept which combines (pleuro-)pneumonectomy or completion pneumonectomy with surgical debridement of the pleural cavity and packing with povidine–iodine soaked dressings. The debridement and packing is repeated in the operating theater after 48 h until the chest cavity is macroscopically clean. Finally, the pleural space is obliterated with antibiotic solution. Results: Between February 1997 and October 2000, 11 patients (average age of 59 years, ranging from 25 to 84) with destroyed lung caused by tuberculosis (six), aspergilloma (two), bronchiectasis (one), esophago-pleural fistula (one) or broncho-pleural fistula after lobectomy for bronchial carcinoma (one) and ongoing chronic infection with acute empyema (ten) (25–2500 days between first and definitive therapy) were treated. Pleural culture findings showed Aspergillus in four, Mycobacterium in two, Enterococcus in two, Candida in one and Staphylococcus in one, respectively. The mean number of interventions was 2.9 (2–4). The chest was definitively closed in all patients within 1 week. The mean hospitalization time was 19 days (9–31 days).In the follow-up (10–54 months), there was no recurrence of empyema. One patient (84 years) died at day 31, due to sepsis. Conclusions: Pneumonectomy combined with repeated surgical debridement and antimicrobial therapy enables the successful treatment of chronic pulmonary infection with empyema within a short time period.

Key Words: Pneumonectomy in chronic infection • Empyema • Packing of pleural cavity • Pleural space obliteration

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