“Video Assisted Thoracoscopic Surgery (VATS) for all Stages of Empyema Thoracis: a Single Centre Experience”

Abstract

Video assisted thoracoscopic surgery (VATS) is a surgical treatment option for empyema thoracis (ET). However, very few studies have been reported from India. The present study aims to evaluate the role, implementation and outcomes of VATS for all stages of ET. A prospective evaluation of 33 patients with ET managed by VATS decortication from January 2016 to December 2017 was performed. All were followed up for 6 months to evaluate surgical outcomes, conversion rate, morbidities and relapse.Out of 33, 5 patients had stage I, 18 had stage II and 10 had stage III empyema. Most common symptoms were dyspnea [75.75%] and fever [63.63%]. Commonest etiology was bronchopulmonary infection (51.51%) and tuberculosis (33.33%). Conversion rate was 3.03%. Mean operating time was 102, 178.8 and 323 min for stage I, II, III respectively. Mean hospital stay for stage I, II,III was 4, 5.11 and 9.3 days respectively. Intraoperative bleeding was high in stage III (625 ml) compared to stage II (327.7 ml). Mean chest tube duration for stage I, II and III was 13.4, 10.2 and 14.8 days respectively. VATS decortication is safe, feasible and effective treatment for all ET stages, when preformed in properly selected patients at appropriate time by experienced surgeons. It improves outcomes in stage I ET by reducing recurrence in cases with failure of conservative management. When timed appropriately, it has acceptable morbidity and postoperative recovery rates without significant conversion rates, even in stage III ET.