Thoracoscopic Decortication versus Open Decortication in Chronic Empyema

Background: Many recent reports have encouraged the use of VATS in the management stage II empyema. The technical difficulty caused by pleural adhesions, is not considered an obstacle hindering the procedure anymore. Furthermore, thoracic surgeons around the world are increasingly trying to manage patients with stage III empyema solely using VATS. This current study aims to compare the results of surgical decortication for empyema using the VATS and thoracotomy approaches.

Patients and Methods: This prospective comparative non-randomized clinical study was carried out in the Department of Cardiothoracic Surgery of Kasr el Ainy faculty of medicine Cairo University from September 2016 till May 2018. The study encompassed 60 patients who had empyema and scheduled for surgery. The study patients were divided into 2 matching groups. Group A (thoracoscopic decortication), and group B (open decortication). All were studied for early outcome.

Results: In the VATS group (group A) the conversion rate to open thoracotomy was 33.3%. The mean operative time was similar in to the thoracotomy group (group B). The successful achievement of fully expanded lungs was higher in the VATS group (93.3% vs. 80%, p=0.129). VATS also showed less pain (2.27 ± 1.64 vs. 4.27 ± 2.05, p=0.001*), less wound complications (0% vs. 13.3%, p=0.038*), and shorter hospital stay (5.27 ± 3.90 vs. 8.07 ± 5.36, p=0.003*).

Conclusion: We concluded that VATS is safely feasible in the organized, late stage III pleural empyema, and thus should be considered as the preferred approach when addressing chronic empyema, as long as complete re-expansion of the lung can be achieved. Moreover, conversion to the open technique should be done whenever necessary, to avoid undesired postoperative morbidity.