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A Journal on Surgery

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Chirurgia 2004 October;17(5):147-52


language: English

Treatment of pleural empyema. A series of 941 cases

Sollitto F., De Palma A., Loizzi D., Loizzi M.


Aim. From July 1958 to December 2002, we evaluated and treated 941 cases of pleural empyema.
Methods. It was caused by pneumonia in most cases (454, 48,2%), by direct infection in 220 (23,4%); was complication of pneumonectomy in 50 (5,3%) and of lobar resection in 91 (9,7%); various conditions were responsible in 126 (13,4%).
Results. In 190 cases (20,2%) simple pleural drainage and cleansing (using VATS in 50 cases) led to complete resolution. Chronic illness developed in 751 (79,8%): 620 underwent decortication, with complete resolution in 607; 7 required subsequent muscular or musculocutaneous flap closure; 6 died of septic shock. Of the remaining 131, after drainage, 129 underwent thoracostomy, with subsequent muscular or musculocutaneous flap transposition and an eventual thoracoplasty in 110 patients: complete resolution was observed in 100, a new empyema cavity appeared in 7, and 3 died. In one patient controlateral thoracotomy was successfully performed to repair a left broncho-pleural fistula; in another one a right broncho-pleural fistula was repaired transposing a double muscle-rib flap in the lumen of the bronchus and a musculocutaneous flap of rectus abdominis in the pleural space.
Conclusion. Early diagnosis and immediate drainage of the pleural cavity are fundamental in the management. Empyemas sustained by persistent infection or formation of broncho-pleural fistula require open drainage and successive debridement of the pleural cavity with muscular or musculocutaneous flap transposition and an eventual thoracoplasty; in selected cases controlateral surgical approach should be considered.

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