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Chronic postpneumonic pleural empyema: comparative merits of thoracoscopic versus open decortication

^a Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
^b Department of Studi Geoeconomici, Linguistici, Statistici, Storici per l’Analisi Regionale, La Sapienza University of Rome, Rome, Italy

Received 16 February 2009; received in revised form 23 May 2009; accepted 12 June 2009.

^_* Corresponding author. Address: Unit of Thoracic Surgery, Carlo Forlanini Hospital, Via Portuense 332, 00149 Rome, Italy. Tel.: +39 06 55180681; fax: +39 06 6638734. (Email: gcardillo{at}scamilloforlanini.rm.it).

Objective: We seek to evaluate the comparative merits of thoracoscopic versus open decortication in the surgical management of patients with chronic postpneumonic pleural empyema. Methods: From January 1996 to December 2006, 308 patients (180 males, 128 females, mean age: 56.3 years, range: 17–82 years) with chronic postpneumonic pleural empyema underwent decortication after failure of conservative treatment. Results: Decortication was performed by open thoracotomy in 123 (39.9%) patients (OT) and by videothoracoscopy (VT) in 185 (60.1%). Mortality was 1.29% (4/308). Morbidity was 21.1% (65/308). At 6 months follow-up, three VT patients showed recurrent empyema and underwent re-do surgery by video-assisted-thoracoscopy (VATS) (one patient) or by thoracotomy (two patients). The videothoracoscopic approach showed statistically significant better results in terms of in-hospital postoperative (day 1 and day 7), pain (p < 0.0001), postoperative air leak (p = 0.004), operative time (p < 0.0001), hospital stay (p = 0.020) and time to return to work (p < 0.0001). The analysis of postoperative pain at 6 months follow-up showed no significant differences among the different groups. Conclusions: In the light of our experience, videothoracoscopic decortication appears to be the surgical treatment of choice for chronic postpneumonic pleural empyema even if a multicentric-randomised trial should be performed before videothoracoscopic decortication becomes the gold standard for the treatment of pleural empyema.

Abbreviations: VATS = video-assisted-thoracoscopy • CH = Charrier

Key Words: Empyema • Thoracoscopic surgery • Pleural diseases