Rigid thorascopic debridement and continuous pleural irrigation in the management of empyema

Study objective To determine the role of rigid thoracoscopy and continuous pleural irrigation as an alternative to thoracotomy in critically ill patients. Design/setting/patients/interventions Thirteen patients with empyema (one bilateral) underwent thorascopic decortication and continuous postoperative irrigation with normal saline solution. Seven patients required preoperative ventilator support. Measurements and results Double-lumen intubation was utilized in only two cases. Empyemas were drained effectively in all patients, including nine patients in whom dense adhesions were encountered. Mean duration of irrigation was 3.5±0.5 days. There were no deaths. One patient developed a recurrent empyema 1 week after resolution of symptoms and underwent thoracotomy. Conclusions Rigid thorascopic decortication is an effective method for treating empyemas and can be considered before thoracotomy. It can be performed in patients who might not be candidates for video-assisted thorascopic approaches owing to inability to tolerate one-lung anesthesia or who have dense adhesions preventing lung collapse.