A review of 16 cases of thoracoscopic surgery for adult acute empyema

Abstract

We reviewed 16 cases of acute empyema, which underwent video-assisted thoracoscopic surgery (VATS) from January 2003 to December 2005. The patients were 13 males and 3 females, and ranged from 25 to 82 years (mean: 61 years) of age. The duration of preoperative symptoms, postoperative drainage, and postoperative hospital stay were 10 to 50 days (median: 26 days), 9 to 62 days (median: 12.5 days), and 14 to 106 days (median: 22.5 days). All patients were discharged and there were no operative mortalities. Ten cases were operated on in the fibropurulent phase and 6 cases in the organized and chronic phase. Operations were performed through 2 ports in 9 patients and 3 ports in 6 patients. One patient with chest wall abscess needed mini-thoracotomy, but no patients required conversion to standard open thoracotomy. As for complications, empyema recurred in 3 patients and airleak persisted in 1 patient. These patients were cured by conservative treatment or second VATS debridement. VATS is a safe and effective method in the management of acute empyema, and it is favorable to perform it in the fibropurulent phase. However, it is also effective in the early organized and chronic phase. In cases of acute empyema caused by methicillin-resistant Staphylococcus aureus (MRSA), it may be recommended to add postoperative treatment such as irrigation of the pleural cavity, because empyema often recurs.