Pleural empyema management: The impact of Video-assisted thoracoscopic surgery

Abstract

In recent years, Video-assisted Thoracoscopic Surgery (VATS) has caused many changes in thoracic surgery practice. This study aimed to analyze the results of early VATS surgery in patients with empyema. Thirty-two cases of empyema who underwent VATS drainage, debridement, pleural pouch jointing, and partial decortication between November 2018 and June 2022 were included in the study retrospectively. The cases were examined for demographic information, the duration of symptoms, the stages of empyema, treatment outcomes, and complications. Twenty-three (79.9%) cases were male, 9 (28.1%) were female, and the mean age was 46.4±19.9. Preoperative symptom duration was 2.68±1.46 weeks. 28 (87.5%) cases were in stage 2 and 4 (12.5%) cases were in stage 3 empyema. A single incision VATS was performed in 23 (71.9%) cases, and double incision VATS was performed in 9 (28.1%) cases. Postoperative hospital stay was 12.1±3.3 days. Acceptable symptomatic and radiological improvement was observed in 28 (87.5%) cases after VATS. Pleural decortication with thoracotomy was used in four (12.5%) cases of stage 3 empyema. In cases of stage 2 empyema, which occurs within the first four weeks of the onset of symptoms, the VATS procedure with drainage, debridement, pouch jointing, and partial decortication provides curative results. We recommend evaluating VATS as the first-line therapy in treating early-stage empyema.