Hippocrates Quoted "If an Empyema Does Not Rupture, Death Will Occur": Is Medical Thoracoscopy Able to Make It Rupture Safely?. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: Hardavella, Georgia; Papakonstantinou, Nikolaos A.; Karampinis, Ioannis; Papavasileiou, Gerasimos; Ajab, Shereen; Shafaat, Mohammed; Malagaris, Stavros; Anastasiou, Nikolaos
• Is Part Of: Journal of bronchology & interventional pulmonology. Volume 24:Issue 1(2017)
• Publication Date: 2017-01
• Subjects: empyema -- medical thoracoscopy -- thoracoscopy -- local anesthesia -- debridement; Bronchoscopy -- Periodicals; Lungs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Lung Diseases -- surgery -- Periodicals; Diagnostic Techniques, Respiratory System -- Periodicals; Bronchi; Bronchoscopy; Lungs -- Diseases; Periodicals; 616.23
• DOI: 10.1097/LBR.0000000000000310
• Languages: English
• ISSNs: 1944-6586

Abstract

Abstract : Background: The aim of this study was to evaluate the safety and efficacy of medical thoracoscopy through a single port [single-port medical thoracoscopy (S-MT)] for the treatment of empyema thoracis in its early stages. Methods: We performed a retrospective analysis reviewing the medical records of 84 patients referred for empyema and treated by medical thoracoscopy at our Thoracic Departments from January 2001 until November 2014. S-MT was performed under local anesthesia with neuroleptoanalgesia and spontaneous breathing using a single 1-cm incision for debridement and lavage of the pleural cavity. Results: A total of 84 patients underwent S-MT for pleural empyema stage I (9 patients, 10.7%) or II (75 patients, 89.3%). Median age was 61.8 years (range, 18 to 84 y). Male to female ratio was 3.76. Surgery was performed 5 to 26 days after the onset of symptoms. Macroscopically complete debridement of the pleural cavity was achieved in 71 patients (84.5% of cases). The rest 15.5% of cases required video-assisted thoracoscopic surgery or open decortication due to trapped-lung syndrome. Median operation time was 45 minutes (range, 30 to 94 min). No intraoperative complications occurred. In-hospital mortality was zero, whereas in-hospital morbidity rate was 16.7%. Median hospital stay was 7.8 days (range, 3 to 18 days). Recurrence rate was 4.8% as 4 patients experienced a relapse of empyema. Conclusion: It seems that S-MT is a minimally invasive, safe and effective procedure for the treatment of pleural empyema with very good results in early stages of the disease and reduced time of hospital stay.