Post-pneumonectomy empyema

Abstract

Empyema remains a formidable complication following pneumonectomy, and compounds the mortality of such major surgery. Our experience of 41 cases of post-pneumonectomy empyema (PPE) is presented. There is no universally appropriate treatment and management depends upon the patient's general condition and the presence of associated fistulas. Initial management consists of drainage in all cases. This may be continued if the patient is unfit for further procedures or if there is any doubt about the possibility of an early relapse. Since 1979, we have treated 23 cases of PPE not associated with bronchopleural fistula (BPF) ("simple" PPE). All were treated by rib resection and open drainage. Subsequently in four patients, Portovac drainage eradicated the space and infection within 3 and 12 months. One patient died of pulmonary embolus one day after open drainage. Three patients were unfit for further treatment and one patient refused further treatment. One patient underwent Schede thoracoplasty and had no further infection. Thirteen patients were re-admitted after a period of open tube drainage (3-28 weeks), the infected space was irrigated to sterility and closed. This was successful in eight cases which have remained sterile 9 months to 9 years later. Five patients developed recurrent PPE and three patients have remained sterile following repeated irrigation and closure. The management of PPE is further complicated by concurrent fistulas. Since 1979, 18 patients have had PPE complicated by fistula ("complex" PPE), often recurrent following previous unsuccessful attempts at closure. Treatment has been individualized, and has often required further major surgery. Small BPFs closed with drainage and the space was obliterated with Portovac drainage in three patients.(ABSTRACT TRUNCATED AT 250 WORDS)