Thoracotomy and decortication in chronic empyema (fibrothorax), in the era of video assisted thoracic surgery

Abstract

Background: Traditionally, open thoracotomy and decortication with or without pleurectomy is the treatment of chronic empyema in the stage of fibrothorax. Some recent reports have claimed similar clinical results by video assisted thoracoscopic surgery (VATS) with less morbidity and mortality than open surgery. Our experience with thoracotomy and decortication with or without pleurectomy for fibrothorax is reviewed, in this study. Aim was to evaluate results of the results of open thoracotomy and decortication with or without pleurectomy in patients with chronic empyema in the stage of fibrothorax.Methods: From September 2007 to March 2012, 126 patients with diagnosis of empyema thoracic were treated at institute. Diagnosis of chronic empyema was based on-duration of signs and symptoms before definitive treatment and imaging findings- such as constriction of thoracic cage and lungs. 56 patients fulfilled the criteria for chronic empyema and then underwent open thoracotomy and decortication.Results: 39 patients (69.6 %) were males, 17 patients (30.35 %) were females. Mean age of study group was 31.4 years. Etiology was synpneumonic effusion in 49 patients (87.5 %) sub pleural malignancy in 3 patients, traumatic haemothorax in 2 patients and ruptured hydatid cyst in 2 patients. The mean duration of symptoms and signs before definitive treatment averaged 42 days. All patients had chronic empyema (Fibrothorax), as confirmed by imaging and operative findings. There were 3 patients (5.4 %) with complications and one mortality. The postoperative length of stay averaged 11.2 days. There were no recurrences of empyema. Complete expansion of lung was confirmed by imaging in 53 patients at the end of 3 months on follow up.Conclusions: Treatment for chronic empyema thoracic with Fibrothorax can be achieved with open thoracotomy and decortication with low complication rates and low mortality with satisfactory results.