The usefulness of thoracoscopic surgery for pleuritis carcinomatosa
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Keywords:
Decortication
Thoracoscopy
Cardiothoracic surgery
Thoracostomy
Chest tube
Video-assisted thoracoscopic surgery
Pleural disease
Of the 31 children treated for empyema thoracis secondary to pneumonitis at the Loma Linda University Medical Center, Loma Linda, Calif, from 1980 to 1990, 23 responded to prompt directed antibiotic therapy coupled with drainage, usually tube thoracostomy. All patients were cured clinically; some demonstrated residual pleural reaction with chest roentgenography or computed tomography that resolved over time. Decortication was necessary in eight severely ill children; three required concurrent lung resection for abscess. Distinct from the nonoperated group, there was a pattern of initial antibiotic trials in these patients averaging 6.5 different drugs plus delayed drainage of effusions. Delay in the initiation of antibiotic therapy was six times longer for the operated vs the nonoperated group. Delay to tube thoracostomy was 18 days for the decorticated children compared with 5.4 days for the nondecorticated children. All eight children responded completely and rapidly to their decortications. Roentgenographic changes lagged considerably behind the clinical course of the child, and computed tomographic scans provided better identification of chest tube placement but little information predictive of the need for decortication. Decortication for empyema seldom is necessary when a child is treated promptly with appropriate antibiotics directed by thoracentesis findings, and drainage, usually tube thoracostomy. The criterion for decortication is persistent sepsis, not the roentgenographic appearance of the chest.
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Decortication
Thoracostomy
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Decortication
Bronchopleural fistula
Thoracostomy
Cardiothoracic surgery
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To evaluate the effectiveness of surgical intervention in managing empyema thoracis in children.A total of 70 patients aged 1-14 years diagnosed to have empyema thoracis and who underwent tube thoracostomy from January 2010 to December 2013 were studied. All patients of which 12 patients needed decortication.The mean age of the study group was 5.44 years and 48.6% were male and 51.4% were female. The most common symptoms at admission were fever (90%), dyspnoea (73%), cough (70%) and chest pain (23%). Pleural fluid cultures were sterile in 60% of patients. The most frequently identified micro-organisms was Staphylococcus aureus (34.2%). Treatment with chest tube drainage was successful in 55 (78.6%) patients. Three patients got expired. Twelve patients had decortications, all of which were successful. The lung re-expansion time was 8.00 ± 1.68 days (range: 5-13 days) in those patients in whom chest tube drainage was successful, whereas it was 7.50 ± 2.623 days (range: 4-14 days) in patients in whom decortication was done. The post-procedure stay was 10.00 ± 1.809 days (range: 7-15 days) in patients with successful chest tube drainage and 9.5 ± 2.902 days (range: 6-17 days) in case of decortication cases.Tube thoracostomy should be done in all cases of empyema thoracis regardless of stage, as this leads to reduction in septic load. Decision of decortication should be taken without any delay.
Decortication
Thoracostomy
Chest tube
Pleural empyema
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Background: Surgical intervention such as video-assisted thoracoscopic surgery (VATS) has shown the benefit of reducing morbidity and mortality in the management of pleural empyema. The objective of the study was to investigate preoperative factors that could predict the need for VATS rather than chest tube thoracostomy.Methods: This is retrospective observational study of consecutive patients diagnosed with pleural empyema admitted to the Dr. Zainoel Abidin Hospital, Banda Aceh in period of 2015 to 2017. The demographic, clinical dan laboratory data of the patients were evaluated from hospital medical records.Results: A total of 48 consecutive patients were identified. The mean age of the patients was 34.3 ± 20.4 years; and 31 (64.6%) were male. Twenty-six patients underwent VATS decortication and twenty-two patients underwent chest tube thoracostomy. Patient demographics were similar between VATS decortication and chest tube thoracostomy group. The significant preoperative factors associated with the VATS were serum albumin level and leukocytes (p <0.05). The mean serum albumin level was 2.81 ± 0.44 g/dL for the VATS decortication group vs 3.06 ± 0.41 g/dL for the chest tube thoracostomy group (p = 0.047). In addition, serum leukocyte level was higher in VATS decortication group compared to chest tube thoracostomy group (21,600 mm-3 vs 12,900 mm-3; p = 0.024).Conclusion: We demonstrate that a low serum albumin level or an elevated leukocyte level may represent as preoperative factors in which surgical treatment may be required in the management of pleural empyema.
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Chest tube
Thoracoscopy
Demographics
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Post-traumatic empyema has occurred in seven patients despite chest tube drainage and antibiotics. Early pleural decortication resulted in complete recovery of all patients with early discharge from the hospital in most instances. The surgical procedure is technically simple to perform if carried out before the organization of the pleural exudate. Criteria are offered for early decortication of the lung for post-traumatic empyema. They are: 1) Residual air-fluid levels despite chest tube drainage. 2) A clinically deteriorating course with evidence of infection or sepsis arising from the pleura. 3) Pleural restriction with inadequate expansion of the lung resulting in compromised ventilatory function. 4) Failure of chest tubes to allow for resolution of pleural contamination within 14 days of injury. If such indications are employed, excellent results can be anticipated from early decortication of post-traumatic empyema.
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Thoracostomy
Chest tube
Pleural empyema
Chest injury
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Decortication post-traumatic empyema (PTE) was performed in 27 patients from 1972 through 1977. All 27 patients had penetrating chest wounds and were refractory to antibiotics and tube thoracostomy. Factors associated with PTE included unrecognized diaphragmatic perforation, large hemothorax greater than 500 ml, pulmonary contusion, extrathoracic extension of hematoma within the chest wall, and incomplete expansion of the lung with initial tube thoracostomy. Prophylactic antibiotic usage did not prevent PTE nor lead to negative intrapleural cultures preoperatively. The timing of decortication varied with indication: two patients with infected pneumothorax had surgery within 1 week; 15 patients with infected pleural clot had surgery within 4 weeks; ten including nine who were readmitted to the hospital had surgery more than 4 weeks after injury. Prevention of PTE requires early recognition of hemo- or pneumothorax, early tube thoracostomy with complete evacuation of blood and expansion of lung, careful daily monitoring of subsequent fluid accumulation, and prompt evacuation when such fluid accumulates. Once PTE becomes well established and refractory to standard modalities, decortication with evacuation of the empyema cavity should be performed as soon as possible.
Decortication
Etiology
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Decortication
Thoracostomy
Parapneumonic effusion
Chest tube
Pleural empyema
Pleural cavity
Pleural disease
Pleurisy
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Abstract Background: The study investigated whether surgical decortication with or without pre-operative tube thoracostomy for phase II and III empyema have equal outcomes. Methods: We included 1,042 patients with phase II or III empyema underwent surgical decortication from January 2012 to December 2021. Patients were classified into two groups: sole operation, operation after tube thoracostomy. Primary outcomes were peri-operative and in-hospital characteristics. Secondary outcomes analyzed 1-year overall survival rate and 1-year event free survival. Results: 620 patients after 1: 1 propensity matching score were conducted. The sole operation group had significant lower hospital mortality and 30-day re-intervention rate and shorter duration between diagnosis to operation, operation time, ICU stay, ventilator duration, and hospital stay. The sole operation group also had higher 1-year overall free survival and 1 event free survival. Conclusions: The first intervention for advanced stage empyema is crucial. Even patients finally received operation, pre-operative tube thoracostomy could lead to poor outcomes. Surgical management directly for phase II and III empyema is simpler and more effective.
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Decortication
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