Comparison of the clinical outcome of pulmonary decortication in two thoracoscopic and thoracotomy procedures in patients with chronic empyema

Abstract

Comparison of the clinical outcome of pulmonary decortication in two thoracoscopic and thoracotomy procedures in patients with chronic empyema.

Background: Pleural effusion is caused by a variety of causes, the most common cause of is pneumonia. Pleural empyema may start from an exudative phase and enter the chronic or organized phase through the fibrinopurulant phase. Chronic pleural empyema is the final phase of pleural empyema. The effusion evacuation procedure in phase II depends on whether the pleural fluid is free or loculated; drainage is performed with a chest tube if free. However, if it is loculated or if the disease is in phase III, the debridement is performed with either open or video-assisted thoracic surgery. The aim of this study was to compare the results of open thoracotomy with Video-assisted thoracic surgery in patients with chronic pleural empyema.

Method and materials: In this descriptive-analytical study, 60 patients with chronic pleural empyema who underwent pulmonary decortication surgery were examined. The patients were divided into two groups: thoracotomy and thoracoscopy. Required information for study including age, gender, surgical procedure, duration of surgery, length of hospital stay, etc from patient records extracted. These cases were compared between the two groups.

Results: Sixty patients, with mean age 41.97±2.54 (range 2–80) years were enrolled. 30 patients underwent thoracotomy and 30 patients underwent thoracoscopy. The mean duration of surgery in the thoracotomy group was 2.15±0.10 hours and in the thoracoscopic group was 1.44±0.06 hours, which was significantly shorter in the thoracoscopic group (P = 0.018). The length of hospital stay in the thoracotomy group was 14.33±1.42 days and in the thoracoscopic group was 9.43±0.47 days, which was significantly shorter in the thoracoscopic group (P = 0.001). Chest tube retention in the thoracotomy group was 6.63±0.84 days and in the thoracoscopic group was 6.96±0.96 days, which was not significantly different between the two groups (P = 0.417). Postoperative air leak duration in thoracotomy group was 0.53±0.15 days and in thoracoscopy group was 0.026±0.09 days which was significantly lower in thoracoscopy group (P = 0.019). The duration of tachypnea in the thoracotomy group was 2.23±0.36 days and in the thoracoscopic group was 1.80±0.25 days, with no significant difference between the two groups (P = 0.174). Duration of shortness of breath in thoracotomy group was 0.90±0.13 days and in thoracoscopic group 0.63±0.13 days. There was no significant difference between two groups (P = 0.238).