Efficacy of Video-Assisted Thoracoscopic Surgery (VATS) for Management of Empyema Thoracis
* Department of Surgery, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathumthani, Thailand
Affiliation : Boonlawat Homvises MD*
Objective : Empyema thoracis is a frequent clinical problem and share in common a considerable potential for death and
morbidity. Video-assisted thoracoscopic surgery [VATS] debridement or decortication become popular and increase the
available treatment options. The authors aim is to determine the efficacy and outcome of VATS for management of empyema
thoracis in adult patients.
Material and Method: A retrospective study of all adult patient treated for empyema between June 2009 to Feb 2011 at
Thammasat Hospital was conducted. Recorded data included demographic information, clinical presentation, laboratory
data, microbiological data, operative details, postoperative course, follow-up data and complications.
Results : A total of 23 patients [5 women, 18 men] underwent VATS debridement and decorication for treatment of empyema
thoracis. Their mean age was 57 [35-90] years. 17 [74%] patients received preoperative drainage [percutaneous catheter
drainage or tube thoracostomy] and mean duration of preoperative drainage was 7.6 [3-26] days. 8 [35%] patients had
stage II empyema and underwent VATS debridement while 15 [74%] patients had stage III empyema underwent VATS
decortication. Median postoperative hospital stay was 12.6 [7-48] days. Median time for postoperative intercostals drainage
was 5 [3-30] days. Median follow-up time was 5 [1-20] months. Conversion rate to open thoracotomy for stage III empyema
was only 13%. There were 3 postoperative complications [13%]: wound infection [n = 1], persistent space [n = 1] and
recurrent infection [n = 1]. There was no intraoperative death and 2 [8%] perioperative death [< 30 days] which were mostly
unrelated to surgery. Of the 23 patients, 20 patients [87%] achieved satisfactory results with treatment.
Conclusion : VATS debridement and decortication is safe and effective treatment in the management of stage II and stage III
empyema thoracis.
Keywords : Video-assissted thoracoscopic surgery [VATS], Empyema thoracis, Decortication
