Thoracoplasty in the Management of Chronic Empyema: Experience of a Sub Saharan African Country

Abstract

Introduction: The current main indication of thoracoplasty is empyema following or not lung resection, when the other surgical methods such as thoracic drainage, pleurostomy and/or pulmonary decortication have failed or are not useful. The authors report the role of thoracoplasty in the management of chronic empyema. Method: Between 2004 and 2015, eight male patients underwent thoracoplasty, in the Department of Thoracic Surgery at the University Hospital of Fann, Dakar, Senegal. The mean age was 40 years old. In all cases, the first step of the treatment was thoracic drainage with Heimlich valve in an ambulatory patient, associated with antibiotic according to the result of bacterial culture. In three patients, thoracostomy was indicated to control local infection before thoracoplasty. Results: Indications for thoracoplasty were refractory post resectionnal lung empyema in 6 cases and chronic primary apical empyema in 2 cases. Bronchopleural fistula was found in 5 patients. We performed three superior partial thoracoplasty, and five enlarged thoracoplasty. A myoplasty, using latissimus dorsi to fill the empyema space, was associated with thoracoplasty in five cases. Bronchopleural fistula cure consisted of a direct X form suture in two cases and of intercostal muscle apposition on the fistula in others ones. Partial scapulectomy, by resection of the inferior third part of the scapula was done in three patients. After a mean follow up of one year, no patient presented with persistence or recurrence of empyema. Then we concluded that they were healed. Conclusion: Thoracoplasty is an efficient procedure for the management of chronic empyema. So it is necessary for each team to established define criteria that will allow a patient to undergo thoracoplasty in order to do not use it for any desperate case of refractory chronic empyema.