Video-assisted Thoracoscopy in the Treatment of Multi Loculated Pleural Effusion and Empyema

Kim, Young Jin

Abstract

BACKGROUND: Successful treatment of multi-loculated pleural effusion or thoracic empyema requires effective drainage and definitive diagnosis of causative organism. The purpose of this study was to assess the efficacy of the video-assisted thoracoscopic surgery in the management of thoracic empyema or multi-loculated pleural effusion after chest tube drainage treatment had failed. MATERIAL AND METHOD: Between April 2000 and July 2002, 20 patients with thoracic empyema or multi-loculated pleural effusion that failed to chest tube drainage or other procedures who underwent an operation. All patients were assessed by chest-computed tomogram and underwent video assisted thoracoscopic drainage, debridement, biopsy and irrigation of pleural cavity. RESULT: In 18 cases (90%), underwent successful video-assisted thoracoscopic surgery. In 2 cases, decortications by mini-thoracotomy were necessary. The ratio of sex was 4:1 (16 male: 4 female), mean age was 48.9 years old (range, 17~72 years), mean duration of postoperative chest tube placement was 8.2 days (range, 4~22 days), mean postoperative hospital stay was 15.2 days (range, 7~33 days). Causative disease was tuberculosis, pneumonia, trauma and metastatic breast cancer. There were no major postoperative complications. Symptoms improved in all patients and were discharged with OPD follow up.
CONCLUSION
In an early organizing phase of empyema or multi loculated pleural effusion, video-assisted thoracoscopic drainage and debridement are safe and suitable treatment.