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Subject Area

Cardiac Surgery

Article Type

Original Study

Abstract

Objectives This study aimed to assess the results of video-assisted thoracoscopic surgery (VATS) in patients with chronic pleural empyema. Background Empyema thoracis (ET) is an abnormal accumulation of excess fluid in the pleural space because of infective and/or inflammatory process. Chest tube drainage or thoracocentesis is the first-line management choice for early-stage ET. Surgical intervention is the favored first-line treatment option for advanced stages of ET. Controversy still exists about the effectiveness of VATS drainage and decortication in the advanced stages of ET. Patients and methods This is a prospective study that included 30 patients with third-stage empyema. All patients were operated with open posterolateral thoracotomy in Menoufia University Hospital. Patients were followed up 1 month post-discharge from hospital. Results Conversion rate in the VATS group to open thoracotomy was 6.7%, those who converted were excluded from the study. Sixteen (57.1%) patients had positive pleural fluid culture and 10 (35.7%) patients had comorbidities. The mean operation time was 291.07 ± 56.66 min and three (10.7%) patients needed blood transfusion. Intraoperative blood loss was 209.29 ± 80.32 ml. No patients needed postoperative ICU stay or mechanical ventilation. The Wong–Baker FACES pain scale median was 4.0 (2.0–4.0). Of the patients 32.1% had postoperative complications. Conclusion VATS showed hopeful results concerning pain, operative time, blood loss, and early return to daily activities. So, VATS is recommended for the management of third- stage empyema with more accurate selection of cases and upgrading of instruments to decrease the rate of conversion to open thoracotomy.

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