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Surgery Today

, Volume 30, Issue 6, pp 506–510 | Cite as

Surgical treatment for chronic pleural empyema

  • Morihito Okada
  • Noriaki Tsubota
  • Masahiro Yoshimura
  • Yoshifumi Miyamoto
  • Hiroyuki Yamagishi
  • Shinsuke Satake
Original Articles

Abstract

Various surgical procedures have been developed in an attempt to alleviate the significant problems caused by chronic pleural empyema. The present study evaluates our 11-year experience of employing a number of therapeutic approaches for chronic empyema. Between 1987 and 1997, 45 consecutive patients underwent treatment for chronic empyema at our hospitals. They comprised 21 patients (47%) presenting with post-tuberculosis, 11 (24%) receiving cancer therapy including pulmonary resection, and 13 (29%) with postpneumonic empyema. Omentopexy, lung resection, and thoracoscopic surgery were performed in 10 (22%), 5 (11%), and 4 (9%) patients, respectively. Poor results of treatment were observed in two of the patients with post-tuberculous empyema, and three of the patients treated for cancer died of recurrence. The other 40 patients remain symptom-free. An improvement in quality of postoperative life was revealed by the exercise test rather than by static spirometry. Optimal therapy for chronic empyema requires selection of the most appropriate first and staged procedures for each patient. Moreover, lung resection should be minimal. In a critical state, open thoracostomy must be performed as the first procedure, while omentopexy or thoracoplasty should be restricted to selected cases. Dead space and minor air leakage may safely be left behind. A video-assisted procedure can be selected for postpneumonia empyema.

Key Words

chronic empyema thoracostomy omentopexy video-assisted surgery 

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Copyright information

© Springer-Verlag 2000

Authors and Affiliations

  • Morihito Okada
    • 2
  • Noriaki Tsubota
    • 1
  • Masahiro Yoshimura
    • 1
  • Yoshifumi Miyamoto
    • 1
  • Hiroyuki Yamagishi
    • 2
  • Shinsuke Satake
    • 2
  1. 1.Department of Thoracic SurgeryHyogo Medical Center for AdultsAkashi, HyogoJapan
  2. 2.Department of Thoracic SurgeryNational Hyogo Central HospitalSanda, HyogoJapan

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