Single-port video-assisted thoracoscopic surgery in the management of fibrinopurulent empyema: the experience of a single institution

Abstract

BACKGROUND: Acute thoracic empyema requires appropriate diagnosis of the disease stage and on time management. The best time of surgical intervention and treatment options of the fibrinopurulent stage empyema is not precisely determined. This study aimed at assessing the effect of a single-port video-assisted thoracoscopic surgery (VATS), as the first option thorough previous chest tube incision, on management of acute thoracic empyema in the fibrinopurulent stage. METHODS: This cross-sectional, prospective, study was performed on 62 patients with fibrinopurulent empyema, who were non-responsive to chest tube drainage and antibiotic therapy, during February 2014 to September 2018. VATS was performed earlier than the course of medical management time (MMT), 12±3 days, thorough previously planned tube thoracostomy incision (5 th intercostal space) in majority of patients as the opening work. Then, the results were compared with possible published related studies at the same stage but in conventional (12-21 days) MMT time. RESULTS: From a total of 62 patients, 52 were males. The age range was 14-80 years. The median postoperative hospital stay was 6 days. The fever and dyspnea reduced after the operation. In majority of the patients, lung was expanded after the VATS but pleural thickening resolved during a follow-up period of 90±15 days. No intraoperative complications were observed. Morbidity rates were acceptable. Also, two conversions were performed, and two death cases occurred due to comorbidity. Pleural tissue diagnosis showed no malignancy, tuberculosis in two cases, and the necrotic tissue in remainder. CONCLUSIONS: The single-port VATS in the treatment of fibrinopurulent empyema as a first option is a highly effective approach and has better outcome in during 12±3days after MMT. Proper selected initial chest tube incision could be used as the opening work incision in VATS. © 2019 EDIZIONI MINERVA MEDICA