TY - JOUR
T1 - Thoracoscopic management of postpneumonectomy empyema
AU - Gossot, Dominique
AU - Stern, Jean Baptiste
AU - Galetta, Domenico
AU - Debrosse, Denis
AU - Girard, Philippe
AU - Caliandro, Raffaele
AU - Harper, Luke
AU - Grunenwald, Dominique
PY - 2004/7
Y1 - 2004/7
N2 - Background Even when there is no associated bronchopleural fistula, empyema is a serious complication of pneumonectomy. Aggressive surgical treatments are usually applied. However, a minimally invasive approach might achieve satisfactory results in selected patients. Methods Out of 17 patients presenting with a postpneumonectomy empyema (PPE), 11 had a thoracoscopic approach. There were 9 males and 2 females, (age, 38-74; mean, 59 years). Ten patients had no proven bronchopleural fistula (BPF). One of them had a minor (<3 mm) BPF. Empyema was confirmed by thoracentesis and bacteriological examination. All patients had immediate chest tube drainage and underwent emergency thoracoscopic debridement of the empyema. No irrigation was used postoperatively. Results There was no mortality and no morbidity related to the procedure. The average duration of thoracoscopic debridement was 62 minutes (range: 45-80 minutes). In 8 patients the chest tube was removed between the fifth and thirteenth postoperative day (average, 8.6 days). They were discharged between the 9th and 24th postoperative day. In 3 patients, clinical and/or biological signs of infection persisted and reoperation was decided at day 5, day 10, and day 11. All 3 patients underwent open-window thoracostomy. The average follow-up of the 8 patients who underwent only thoracoscopy was 10 months (range, 2-27 months). None had recurrent empyema. The patient who presented with a minor BPF remained asymptomatic and is doing well after a 27 month follow-up. Conclusions Thoracoscopy might be a valuable approach for patients presenting with PPE with or without minor bronchopleural fistula.
AB - Background Even when there is no associated bronchopleural fistula, empyema is a serious complication of pneumonectomy. Aggressive surgical treatments are usually applied. However, a minimally invasive approach might achieve satisfactory results in selected patients. Methods Out of 17 patients presenting with a postpneumonectomy empyema (PPE), 11 had a thoracoscopic approach. There were 9 males and 2 females, (age, 38-74; mean, 59 years). Ten patients had no proven bronchopleural fistula (BPF). One of them had a minor (<3 mm) BPF. Empyema was confirmed by thoracentesis and bacteriological examination. All patients had immediate chest tube drainage and underwent emergency thoracoscopic debridement of the empyema. No irrigation was used postoperatively. Results There was no mortality and no morbidity related to the procedure. The average duration of thoracoscopic debridement was 62 minutes (range: 45-80 minutes). In 8 patients the chest tube was removed between the fifth and thirteenth postoperative day (average, 8.6 days). They were discharged between the 9th and 24th postoperative day. In 3 patients, clinical and/or biological signs of infection persisted and reoperation was decided at day 5, day 10, and day 11. All 3 patients underwent open-window thoracostomy. The average follow-up of the 8 patients who underwent only thoracoscopy was 10 months (range, 2-27 months). None had recurrent empyema. The patient who presented with a minor BPF remained asymptomatic and is doing well after a 27 month follow-up. Conclusions Thoracoscopy might be a valuable approach for patients presenting with PPE with or without minor bronchopleural fistula.
KW - 14
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U2 - 10.1016/j.athoracsur.2004.02.023
DO - 10.1016/j.athoracsur.2004.02.023
M3 - Article
C2 - 15223442
AN - SCOPUS:3042623429
VL - 78
SP - 273
EP - 276
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -