Publication: Evolving Experience in The Management of Empyema Thoracis
Files
Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Empyema thoracis a disease of significant morbidity and mortality, especially in the
developing world. However, the optimal management of empyema thoracis remains
controversial.
Objective
To analyse evolving experience in clinical presentation, management, outcome and
factors contributing to adverse morbidity in empyema thoracis.
Methods
This is hospital based retrospective study of patients who were diagnosed with empyema
thoracis in cardiothoracic and vascular surgery (CTVS) unit, Bir Hospital, Kathmandu,
Nepal over a period of one year (July 2009 to June 2010). A total of forty-six adult
cases were categorized into two treatment groups: (i) thoracotomy for decortication (ii)
segmentectomy, lobectomy and redo-thoracotomy for pneumonectomy. The median
duration of illness prior to hospital admission was compared. The presence of loculated
pleural fluid determined the need for thoracotomy.
Results
Out of forty-six cases, twenty- nine (63.04%) who had early thoracotomy (<22 days) had
prompt symptomatic recovery. Forteen out of seventeen (82.35%) of the patients who
were initially treated with thoracocentesis or tube thoracostomy eventually needed
thoracotomy. There was a positive shift in management towards early thoracotomy
resulting in prompt symptomatic recovery. Significant complications were noted in eight
patients who had delayed thoracotomy. Complications included recurrent empyema
with lung abscess (n = 3), restrictive lung disease (n = 3), bronchopleural fistula (n = 1)
and scoliosis (n=1).
Conclusion
Early thoracotomy and decortication was found to be an excellent surgical procedure
with good functional results and high patient satisfaction rate.
KEY WORDS
empyema, thoracotomy, complications
Description
K Shrestha, S Shah, S Shrestha, S Thulung, B Karki, DP Pokhrel
Department of Cardiothoracic and Vascular Surgery Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal