Thoracoscopic Debridement of Empyema

Abstract

The incidence of postpneumonic empyema has been increasing in recent years in most Western countries. The place of surgery in its management is debatable, with many centers advocating initial pleural drainage and instillation of fibrinolytics, reserving surgery for those who fail to respond to these measures. Some, however, suggest that primary surgery leads to a more rapid recovery and a shorter hospital stay. There is little evidence to convincingly show which is the best approach. The aim of surgery is clearance of debris from the pleural space, with reestablishment of a “single” pleural cavity free of loculations and full reexpansion of the lung. Postoperatively, early mobilization and physiotherapy are key. Thoracoscopy has the advantage of excellent visualization of the whole pleural space and minimal postoperative pain, allowing physiotherapy and mobilization to begin almost immediately.