Razi Journal of Medical Sciences

Background: Empyema remains a challenging issue for thoracic surgeons. In the early stages of empyema antibiotic therapy and pleural space drainage are the treatment of choice. In organized empyema with pleural peel and re-expandable underlying lung, decortication is the procedure of choice. There is agreement about the value of Video Assisted Thoracoscopic Surgery (VATS) in the management of stages I and II empyema, but there are doubts about its efficacy in stage III empyema. We seek to evaluate the comparative merits of thoracoscopic versus open decortication in the surgical management of patients with chronic postpneumonic pleural empyema.

Methods: From March 2004 to December 2010, 50 patients (43 males, 7 females, mean age: 37.6 years, range: 13-75 years) with chronic postpneumonic pleural empyema underwent decortications. It was a retrospective cross-sectional study. The data was gathered by investigating the patients medical records and analysed by SPSS17.

Results: Decortication was performed by open thoracotomy in 29 (58%) patients and VATS in 21 (42%). Mortality was 6.5% .There was no difference in terms of re-operation, mortality and success rates. The operation time in (OT) thoracotomy group was shorter (p=0.03). Hospital stay, drainage duration and antibiotic therapy in VATS group was shorter. There was no statistical difference in regard to the success rate between the two groups.

Conclusion: According to the results of this study we found that success rate of VATS decortication is comparable to open thoracotomy, however, a multicentric-randomized trial should be performed before video thoracoscopic decortication becomes the gold standard for the treatment of pleural empyema.