Videoassisted decortication for pleural empyema – alternative to conventional treatment? Indication, technique, results

Objectives: With evolving experience video-assisted thoracoscopic surgery (VATS) was introduced in the management of pleural empyema (VATS-decortication). It remains still under discussion, what patients (pts) are suitable for and what are the limitations of VATS-decortication. Methods: We retrospectively analyzed all pts (n=37) that were treated either by VATS- (VD, n=18) or open decortication (OD, n=19) at our institution in 2004. Pts were analyzed for pre-, intra- and postoperative parameters. Results: The mean age of the pts was 50±14 years (VD: 46±12, OD: 54±15) with a mean hospitalization time of 27.5±21 days. There were differences between both groups in the preoperative (VD: 5.7±5.5, OD: 18.8±22.9 days) and postoperative hospitalization time (VD: 10.2±6.9, OD: 20.2±8.1). The mean operation time was 137±64 minutes (VD: 98±30, OD: 173±67). Conversion to open decortication was required in 5 pts. Conclusion: VATS-decortication is an efficient alternative to open decortication for pleural empyema. The shorter hospitalisation times in pts treated with VATS-decortication may also be due to patient selection (open decortication used for more advanced stages).