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Tsukamoto Y, Odaka M, Nakada T, Yabe M, Harada E, Akiba T, Toya N, Ohtsuka T. Comparative study of local versus general anesthesia in video-assisted thoracoscopic surgery for empyema. Asian J Surg 2023; 46:4208-4214. [PMID: 36504150 DOI: 10.1016/j.asjsur.2022.11.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study evaluated the feasibility of performing non-intubated video-assisted thoracoscopic surgery (VATS) with local anesthesia for parapneumonic effusion and empyema resistant to conservative treatment. METHODS We retrospectively reviewed 80 patients who underwent surgery for parapneumonic effusions and empyema between 2015 and 2021. Patients were divided into those who received non-intubated local anesthesia and general anesthesia during surgery. Patient demographics, characteristics, laboratory findings, treatment progress, and treatment outcomes were compared. The primary outcomes were duration of postoperative drainage, postoperative complication rate, and postoperative mortality rate within 30 days. RESULTS Among patients who received local (n = 21) and general anesthesia (n = 59), there was a significant difference in age (median 79.0 years [interquartile range (IQR) 77.0-80.0] vs. 68.0 years [IQR 54.5-77.5]; p < 0.001), preoperative performance status (3.0 [IQR 2.0-4.0] vs. 2.0 [IQR 1.0-3.0]; p < 0.001), and operative time (69 min [IQR 50-128] vs. 150 min [IQR 107-198]; p < 0.001) but not in preoperative white blood cell count (12,100/μL [IQR 8,400-18000] vs. 12,220/μL [IQR 8,950-16,724]; p = 0.840), C-reactive protein (15.2 mg/dL [8.8-21.3] vs. 17.9 mg/dL [IQR 9.5-23.6]; p = 0.623), postoperative drainage period (11 days [IQR 7-14] vs. 9 days [7-13]; p = 0.216), postoperative hospital stay (22 days [IQR 16-53] vs. 18 days [IQR 12-26]; p = 0.094), reoperation rate (9.5% vs. 15.3%; p = 0.775), postoperative complication rate (19.0% vs. 18.6%; p = 0.132), or postoperative 30-day mortality rate (4.8% vs. 0%; p = 0.587). CONCLUSIONS VATS using local anesthesia is feasible for patients with treatment-resistant parapneumonic effusion and empyema with poor general condition.
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Affiliation(s)
- Yo Tsukamoto
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan.
| | - Makoto Odaka
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Takeo Nakada
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Mitsuo Yabe
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Eriko Harada
- Department of Surgery, The Jikei University Hospital, Nishishinbashi 3-19-18, Minatoku, Tokyo, 105-8471, Japan
| | - Tadashi Akiba
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Naoki Toya
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Takashi Ohtsuka
- Department of Surgery, The Jikei University Hospital, Nishishinbashi 3-19-18, Minatoku, Tokyo, 105-8471, Japan
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Chaddha U, Agrawal A, Feller-Kopman D, Kaul V, Shojaee S, Maldonado F, Ferguson MK, Blyth KG, Grosu HB, Corcoran JP, Sachdeva A, West A, Bedawi EO, Majid A, Mehta RM, Folch E, Liberman M, Wahidi MM, Gangadharan SP, Roberts ME, DeCamp MM, Rahman NM. Use of fibrinolytics and deoxyribonuclease in adult patients with pleural empyema: a consensus statement. THE LANCET RESPIRATORY MEDICINE 2021; 9:1050-1064. [PMID: 33545086 DOI: 10.1016/s2213-2600(20)30533-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
Although our understanding of the pathogenesis of empyema has grown tremendously over the past few decades, questions still remain on how to optimally manage this condition. It has been almost a decade since the publication of the MIST2 trial, but there is still an extensive debate on the appropriate use of intrapleural fibrinolytic and deoxyribonuclease therapy in patients with empyema. Given the scarcity of overall guidance on this subject, we convened an international group of 22 experts from 20 institutions across five countries with experience and expertise in managing adult patients with empyema. We did a literature and internet search for reports addressing 11 clinically relevant questions pertaining to the use of intrapleural fibrinolytic and deoxyribonuclease therapy in adult patients with bacterial empyema. This Position Paper, consisting of seven graded and four ungraded recommendations, was formulated by a systematic and rigorous process involving the evaluation of published evidence, augmented with provider experience when necessary. Panel members participated in the development of the final recommendations using the modified Delphi technique. Our Position Paper aims to address the existing gap in knowledge and to provide consensus-based recommendations to offer guidance in clinical decision making when considering the use of intrapleural therapy in adult patients with bacterial empyema.
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Affiliation(s)
- Udit Chaddha
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Abhinav Agrawal
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, New Hyde Park, NY, USA
| | - David Feller-Kopman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Viren Kaul
- Department of Pulmonary and Critical Care Medicine, Crouse Health-SUNY Upstate Medical University, Syracuse, NY, USA
| | - Samira Shojaee
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark K Ferguson
- Section of Thoracic Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Kevin G Blyth
- Institute of Cancer Sciences and Glasgow Pleural Disease Unit, University of Glasgow, Glasgow, UK
| | - Horiana B Grosu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John P Corcoran
- Interventional Pulmonology Service, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Ashutosh Sachdeva
- Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD, USA
| | - Alex West
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK; Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Adnan Majid
- Department of Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - Ravindra M Mehta
- Department of Pulmonary and Critical Care, Apollo Hospitals, Bangalore, India
| | - Erik Folch
- Complex Chest Disease Center, Beth Israel Deaconess Medical Center, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - Moishe Liberman
- Division of Thoracic Surgery, University of Montreal, Montreal, QC, Canada
| | - Momen M Wahidi
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, NC, USA
| | - Sidhu P Gangadharan
- Department of Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - Mark E Roberts
- Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK
| | - Malcolm M DeCamp
- Division of Cardiothoracic Surgery, University of Wisconsin, Madison, WI, USA
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
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Jindal R, Nar AS, Mishra A, Singh RP, Aggarwal A, Bansal N. Video-assisted thoracoscopic surgery versus open thoracotomy in the management of empyema: A comparative study. J Minim Access Surg 2020; 17:470-478. [PMID: 33047681 PMCID: PMC8486060 DOI: 10.4103/jmas.jmas_249_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: With a rise in the incidence of thoracic empyema, surgical interventions also have evolved from the traditional open decortication to the current minimally invasive video-assisted thoracoscopic surgery (VATS). In this study, we determine the feasibility of VATS and also put the superiority of VATS over open thoracotomy (OT) to test. Subjects and Methods: Prospective single-centre comparative analysis of clinical outcome in 60 patients undergoing either VATS or OT for thoracic empyema was done between 1st September, 2014, and 1st November, 2018. Furthermore, another group of patients, who were converted intraoperatively from VATS to OT, was studied descriptively. Results: Nearly 75% of the patients were male with a mean age of 45.16 years. Every second patient had associated tuberculosis (TB), attributed to the endemicity of TB in India. When compared with OT, VATS had a shorter duration of surgery (268.15 vs. 178.33 min), chest tube drainage (11.70 vs. 6.13 days), post-operative hospital stay (13.56 vs. 7.42 days) and time to return to work (26.96 vs. 12.57 days). Post-operative pain and analgesic requirement were also significantly reduced in the VATS group (P < 0.0001). Conversion rate observed was 14.2%, the most common reason being the presence of dense adhesions. Conclusion: We conclude that VATS, a minimally invasive procedure with its substantial advantages over thoracotomy and better functional outcome, should be preferred whenever feasible to do so. Also if needed, conversion of VATS to the conventional open procedure, rather than a failure, is a wise surgical judgement.
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Affiliation(s)
- Rohit Jindal
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Amandeep Singh Nar
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Atul Mishra
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ravinder Pal Singh
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Aayushi Aggarwal
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Namita Bansal
- Research and Development Centre, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Thori R, Desai GS, Pande P, Narkhede R, Vardhan A, Mehta H. “Video Assisted Thoracoscopic Surgery (VATS) for all Stages of Empyema Thoracis: a Single Centre Experience”. Indian J Surg 2020. [DOI: 10.1007/s12262-019-02042-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Chest infection is a health care problem in many regions of the world, and pleural empyema is the most common type of surgical chest infection. In the past decennium, the introduction of nonintubated surgery and uniportal video-assisted thoracic surgery changed considerably surgical treatment of pleural empyema. Although the advantages seem evident, the need for randomized controlled trials is necessary to confirm the usefulness. Moreover, in the future, an education and training program for thoracic surgeons and anesthesiologists would allow increasing the number of awake surgical options in caring for patients with stages II to III empyema.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of Surgery and Medical Specialities, University of Catania, Policlinic University Hospital, Catania, Italy.
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Pilav I, Alihodzic-Pasalic A, Musanovic S, Kadic K, Dapcevic M, Custovic O. Efficacy of Video-Assisted Thoracoscopic Surgery (VATS) in the Treatment of Primary Pleural Empyema. Acta Inform Med 2020; 28:261-264. [PMID: 33627927 PMCID: PMC7879437 DOI: 10.5455/aim.2020.28.261-264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Video-Assisted Thoracoscopic Surgery (VATS) has recently occupied a significant place in the surgical treatment of primary pleural empyema (PPE). Patients with anamnesis shorter than 4 weeks have a good chance of being cured only by VATS. As it is not easy to define precisely the beginning of the disease, it is difficult to say strictly to which period VATS method will be successful in PPE treatment. Objective The aim of this study was to determine the efficacy of the VATS method in the surgical treatment of primary pleural empyema. Methods The study included 50 patients with findings appropriate for PPE over a period of three years, in whom the VATS method was applied in the surgical treatment of pleural empyema. Results The established total length of treatment was 13.56 ± 7.98 days and the length of hospital treatment after surgery was 9.90 ± 3.315. The duration of thoracic drainage was 8.06 ± 3.005. Treatment was completed by the primary procedure without additional interventions in 94% of patients. Based on the final outcome, all patients from the clinic were discharged as cured. Conclusion The best time to indicate surgical treatment by using VATS method is history of disease in duration of four weeks Debridement or VATS decortication method is safe and efficient surgical procedure, especially in the first two stages. It is recommended to use this method as the first surgical option for patients in early stages of the disease.
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Affiliation(s)
- Ilijaz Pilav
- Clinic of Thoracic Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Alma Alihodzic-Pasalic
- Clinic of Thoracic Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Safet Musanovic
- Clinic of Thoracic Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Kenan Kadic
- Clinic of Thoracic Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Meho Dapcevic
- Clinic of Thoracic Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Orhan Custovic
- Clinic of Thoracic Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - Johannes Bodner
- Department of Thoracic Surgery, Klinikum Bogenhausen, Munich, Germany.,Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria
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8
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Abstract
The widely accepted and still increasing use of video-assisted thoracic surgery (VATS) in pleuro-pulmonary pathology imposes the need to deal with two major pitfalls: the first is to avoid its unselective use, while the second relates to inappropriate rejection of VATS on the basis of "insufficient radicality". Unlike a quite established role of VATS in lung cancer patients, in patients with pleural empyema, the role of VATS is less clearly defined. The current evidence about VATS in patients with pleural empyema could be summarised as follows: VATS is accepted as a useful treatment option for fibrinopurulent empyema, but the treatment failure rate increases with the increasing proportion of stage III empyema, necessitating further surgical options like thoracotomy and decortication. As both pulmonologists and surgeons deal with diagnosis and treatment of pleural empyema, this article is an attempt to highlight the existing evidence in a more user-friendly way in order to help practising physicians to optimise the use of VATS in these patients. In other words, in the absence of randomised studies comparing VATS and thoracotomy, the key question to be answered is: are there any pre-operative findings that can be used to select patients for initial VATS versus proceeding directly to a thoracotomy?
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Affiliation(s)
- Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Basel, Basel, Switzerland
| | - Didier Lardinois
- Clinic for Thoracic Surgery, University Hospital Basel, Basel, Switzerland
| | - Aljaz Hojski
- Clinic for Thoracic Surgery, University Hospital Basel, Basel, Switzerland
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9
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Jagelavicius Z, Jovaisas V, Mataciunas M, Samalavicius NE, Janilionis R. Preoperative predictors of conversion in thoracoscopic surgery for pleural empyema. Eur J Cardiothorac Surg 2018; 52:70-75. [PMID: 28369294 DOI: 10.1093/ejcts/ezx054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 01/03/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Thoracoscopy is an effective treatment method for pleural empyema; however, it is still not well defined as to which patient subgroups could benefit from it the most. The aim of the study was to identify preoperative factors that could facilitate selecting appropriate surgical intervention and to evaluate early postoperative period. METHODS Seventy-one patients were prospectively included in the study, which was conducted from January 2011 to June 2014. Thoracoscopic surgery for Stage II/III pleural empyema was performed in all patients. Thoracoscopy failed in 18 (25.4%) patients, requiring conversion to thoracotomy. The preoperative factors that could possibly predict conversion were analysed. RESULTS Obliterated pleural space (12 patients) and failure to achieve lung re-expansion (6 patients) were the main reasons for conversion. Multivariable logistic regression analysis demonstrated that each day of illness [odds ratio 1.1 (95% confidence interval 1.0-1.2], P = 0.004] and frank pus [odds ratio 4.4 (95% confidence interval 1.2-15.3), P = 0.021] were independent predictors of conversion. Using receiver-operating characteristic analysis, it was determined that the duration of illness had a high predictive value for conversion [area under the curve 0.8 (95% confidence interval 0.7-0.9), P < 0.001]. The cut-off value for duration of illness was 16 days (sensitivity 94.4%, specificity 54.7%). The conversion group had a significantly greater need for postoperative intensive care unit stay ( P = 0.022) but a lower rate of reoperations ( P = 0.105). CONCLUSIONS Duration of illness and frank pus discovered during thoracocentesis can help in selecting the patient for appropriate intervention. Earlier surgery for pleural empyema can reduce the rate of conversion and reoperation.
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Affiliation(s)
- Zymantas Jagelavicius
- Centre of General Thoracic Surgery, Clinic of Infectious and Chest Diseases, Dermatovenerology and Allergology, Faculty of Medicine, Vilnius University, Vinius, Lithuania.,Department of General Thoracic Surgery, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Vytautas Jovaisas
- Department of General Thoracic Surgery, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Mindaugas Mataciunas
- Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Narimantas Evaldas Samalavicius
- Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, Centre of Oncosurgery, National Cancer Institute, Vilnius, Lithuania
| | - Ricardas Janilionis
- Centre of General Thoracic Surgery, Clinic of Infectious and Chest Diseases, Dermatovenerology and Allergology, Faculty of Medicine, Vilnius University, Vinius, Lithuania.,Department of General Thoracic Surgery, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
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Reichert M, Pösentrup B, Hecker A, Schneck E, Pons-Kühnemann J, Augustin F, Padberg W, Öfner D, Bodner J. Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema-an analysis of 217 consecutive patients. Surg Endosc 2017; 32:2664-2675. [PMID: 29218675 DOI: 10.1007/s00464-017-5961-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 10/23/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pleural empyema is an infectious disease of the chest cavity, with a high morbidity and mortality. According to the American Thoracic Society, pleural empyema gets graduated into three stages, with surgery being indicated in intermediate stage II and chronic stage III. Evidence for the feasibility of a minimally-invasive video-assisted thoracoscopic approach in stage III empyema for pulmonary decortication is still little. METHODS Retrospective single-center analysis of patients conducted to surgery for chronic stage III pleural empyema from 05/2002 to 04/2014 either by video-assisted thoracoscopic surgery (VATS, n = 110) or conventional open surgery by thoracotomy (n = 107). Multiple regression analysis and propensity score matching was used to evaluate the influence of operation technique (thoracotomy versus VATS) on the length of post-operative hospitalization. RESULTS Operation time was longer in the thoracotomy-group (p = 0.0207). Conversion rate from VATS to open surgery by thoracotomy was 4.5%. Post-operative complication- (61 patients in thoracotomy- and 55 patients in VATS-group), recurrence- (3 patients in thoracotomy- and 5 in VATS-group) and mortality-rates (6.5% in thoracotomy- and 9.5% in VATS-group) did not differ between both groups; the length of (post-operative) stay at intensive care unit was longer in the VATS-group (p = 0.0023). Duration of chest tube drainage and prolonged air leak rate were similar among both groups, leading to a similar overall and post-operative length of hospital stay in both groups. Adjusted to clinically and statistically relevant confounders, multiple regression analysis showed an influence of the surgical technique on length of post-operative stay after pair matching of the patients (n = 84 in each group) by propensity score (B = - 0.179 for thoracotomy = 0 and VATS = 1, p = 0.032) leading to a reduction of 0.836 days after a VATS-approach compared to thoracotomy. CONCLUSIONS VATS in late stage (III) pleural empyema is feasible and safe. The decrease in post-operative hospitalization demonstrated by adjusted multiple regression analysis may indicate the minimally-invasive approach being safe, more tolerable for patients, and more effective.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.
| | - Bernd Pösentrup
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Jörn Pons-Kühnemann
- Medical Statistics, Institute of Medical Informatics, Justus-Liebig-University of Giessen, Rudolf-Buchheim Strasse 6, 35392, Giessen, Germany
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Johannes Bodner
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.,Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, Innsbruck, 6020, Austria.,Department of Thoracic Surgery, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany
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El-Sayed Mahmoud Hegab S, Mohamed El-Sayed Eissa M, Aly Aly Abdel-Kerim A, Said Abel Aziz M. Imaging guided streptokinase injected through small bore pigtail tail catheter in management of complicated empyema in pediatrics. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Hsiao CH, Chen KC, Chen JS. Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients. Surg Endosc 2016; 31:1719-1727. [PMID: 27519590 DOI: 10.1007/s00464-016-5164-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/30/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction are risky to receive surgical decortication under general anesthesia. Non-intubated video-assisted thoracoscopy surgery is successfully performed to avoid complications of general anesthesia. We performed single-port non-intubated video-assisted flexible thoracoscopy surgery in an endoscopic center. In this study, the possible role of our modified surgery to treat fibrinopurulent stage of parapneumonic empyema with high operative risks is investigated. METHODS We retrospectively reviewed fibrinopurulent stage of parapneumonic empyema patients between July 2011 and June 2014. Thirty-three patients with coronary artery disease and reduced left ventricular ejection fraction were included in this study. One group received tube thoracostomy, and the other group received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. Patient demographics, characteristics, laboratory findings, etiology, and treatment outcomes were compared. RESULTS Mean age of 33 patients (24 males, 9 females) was 76.2 ± 9.7 years. Twelve patients received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication, and 21 patients received tube thoracostomy. Visual analog scale scores on postoperative first hour and first day were not significantly different in two groups (p value = 0.5505 and 0.2750, respectively). Chest tube drainage days, postoperative fever subsided days, postoperative hospital days, and total length of stay were significantly short in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication (p value = 0.0027, 0.0001, 0.0009, and 0.0065, respectively). Morbidities were low, and mortality was significantly low (p value = 0.0319) in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. CONCLUSIONS Single-port non-intubated video-assisted flexible thoracoscopy surgery decortication may be suggested to be a method other than tube thoracostomy to deal with fibrinopurulent stage of parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction.
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Affiliation(s)
- Chen-Hao Hsiao
- Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
- Genome and Systems Biology Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei, 10002, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei, 10002, Taiwan.
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
- Division of Experimental Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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13
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Scarci M, Abah U, Solli P, Page A, Waller D, van Schil P, Melfi F, Schmid RA, Athanassiadi K, Sousa Uva M, Cardillo G. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg 2015; 48:642-53. [PMID: 26254467 DOI: 10.1093/ejcts/ezv272] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/15/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marco Scarci
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Udo Abah
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Piergiorgio Solli
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Aravinda Page
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - David Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Franca Melfi
- Department of Cardiothoracic Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ralph A Schmid
- Division of General Thoracic Surgery, Berne University Hospital, Berne, Switzerland
| | | | - Miguel Sousa Uva
- Unit of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon, Portugal
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Az. Osped. S. Camillo Forlanini, Carlo Forlanini Hospital, Rome, Italy
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14
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Bagheri R, Tavassoli A, Haghi SZ, Attaran D, Sadrizadeh A, Asnaashari A, Basiri R, Salehi M, Moghadam KA, Tabari A, Sheibani S. The role of thoracoscopic debridement in the treatment of parapneumonic empyema. Asian Cardiovasc Thorac Ann 2013; 21:443-6. [PMID: 24570527 DOI: 10.1177/0218492312466858] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To evaluate the efficacy of early video-assisted thoracoscopic debridement in patients with the fibropurulent phase of parapneumonic empyema. PATIENTS AND METHODS 40 patients with parapneumonic empyema resistant to 2 weeks of antibiotic therapy, were randomly divided into 2 groups. In group 1 (20 patients), antibiotic therapy and irrigation was continued, and in group 2 (20 patients), video-assisted thoracoscopic debridement was performed. The 2 groups were compared in terms of therapeutic results. RESULTS The male/female ratio was 29/11. Group 1 included 16 men and 4 women with a mean age of 54 years, and mean hospital stay was 41 days. Group 2 consisted of 14 men and 6 women with a mean age of 51 years, and mean hospital stay was 23 days. Considering the therapeutic results, 12 patients in group 1 were cured by antibiotic therapy and irrigation, whereas 8 required decortication and pleurectomy with thoracotomy. In group 2, 18 patients were cured by video-assisted thoracoscopic debridement, and 2 underwent thoracotomy and decortication due to intraoperative bleeding. A significant difference in therapeutic results was noted between the groups (p = 0.028). CONCLUSION Video-assisted thoracoscopic debridement provides a high success rate and less invasive treatment for the early stages of empyema.
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Affiliation(s)
- Reza Bagheri
- Cardiothoracic Surgery & Transplant Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Management of pleural empyema with single-port video-assisted thoracoscopy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 7:338-45. [PMID: 23274866 DOI: 10.1097/imi.0b013e31827e26d6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and efficacy of an original technique of single-port video-assisted thoracoscopy (S-VATS) for the minimally invasive treatment of pleural empyema in fibrinopurulent stage. METHODS Single-port video-assisted thoracoscopy was performed under general anesthesia and single-lung ventilation using a 2-cm incision after ultrasound localization of the projected midpoint of the pleural effusion. Through the single access, a video scope and standard thoracoscopy instruments were simultaneously introduced to perform debridement and lavage of the pleural cavity. Postoperatively, patients underwent continuous or intermittent pleural irrigation through the chest tube until microbiological confirmation of sterility of the pleural fluid. RESULTS Between November 2004 and December 2009, a total of 61 patients underwent S-VATS for pleural empyema in stage I (7%) or II (93%). Median age was 63.5 years (range, 22-94 years). Male-to-female ratio was 4.2. Surgery was performed 3 to 60 days after the onset of symptoms. Macroscopically complete debridement of the pleural cavity was achieved in most (98%) cases. Median operation time was 53 minutes (range, 29-90 minutes). No intraoperative complications occurred. In-hospital mortality and morbidity rates were 3% and 16%, respectively. Deaths were caused by diffuse metastatic colon cancer in one case and severe apoplectic insult in the other. Chest tube was removed after a median time of 12 days (range, 4-64 days). Four (6.5%) patients experienced a relapse of empyema; this was caused by complicated residual pleural space (two cases), persistent pleuropulmonary fistula (one case), or both (one case). CONCLUSIONS It seems that S-VATS is a safe and effective procedure for the treatment of pleural empyema in fibrinopurulent stage.
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16
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Marra A, Huenermann C, Ross B, Hillejan L. Management of Pleural Empyema with Single-Port Video-Assisted Thoracoscopy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alessandro Marra
- Department of Thoracic Surgery, Lung Center, Niels Stensen Clinics, Ostercappeln, Germany
| | - Christoph Huenermann
- Department of Pulmonary Medicine, Lung Center, Niels Stensen Clinics, Ostercappeln, Germany
| | - Bernd Ross
- Department of Pulmonary Medicine, Lung Center, Niels Stensen Clinics, Ostercappeln, Germany
| | - Ludger Hillejan
- Department of Thoracic Surgery, Lung Center, Niels Stensen Clinics, Ostercappeln, Germany
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17
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Management of infectious processes of the pleural space: a review. Pulm Med 2012; 2012:816502. [PMID: 22536502 PMCID: PMC3317076 DOI: 10.1155/2012/816502] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/12/2011] [Accepted: 12/17/2011] [Indexed: 11/18/2022] Open
Abstract
Pleural effusions can present in 40% of patients with pneumonia. Presence of an effusion can complicate the diagnosis as well as the management of infection in lungs and pleural space. There has been an increase in the morbidity and mortality associated with parapneumonic effusions and empyema. This calls for employment of advanced treatment modalities and development of a standardized protocol to manage pleural sepsis early. There has been an increased understanding about the indications and appropriate usage of procedural options at clinicians' disposal.
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18
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Comparison of video-assisted thoracoscopic surgery and open surgery in the management of primary empyema. Curr Opin Pulm Med 2011; 17:255-9. [DOI: 10.1097/mcp.0b013e3283473ffe] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Chambers A, Routledge T, Dunning J, Scarci M. Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema? Interact Cardiovasc Thorac Surg 2010; 11:171-7. [DOI: 10.1510/icvts.2010.240408] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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20
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Abstract
Pleural infections represent an important group of disorders that is characterized by the invasion of pathogens into the pleural space and the potential for rapid progression to frank empyema. Previous epidemiologic studies have indicated that empyema is increasing in prevalence, which underscores the importance of urgent diagnosis and effective drainage to improve clinical outcomes. Unfortunately, limited evidence exists to guide clinicians in selecting the ideal drainage intervention for a specific patient because of the broad variation that exists in the intrapleural extent of infection, presence of locules, comorbid features, respiratory status, and virulence of the underlying pathogen. Moreover, many patients experience delays in both the recognition of infected pleural fluid and the initiation of appropriate measures to drain the pleural space. The present review provides an update on the pathogenesis and interventional therapy of pleural infections with an emphasis on the unique role of image-guided drainage with small-bore catheters.
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Affiliation(s)
- John E Heffner
- Department of Medicine, Providence Portland Medical Center, Oregon Health and Science Center, Portland, OR.
| | - Jeffrey S Klein
- Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, VT
| | - Christopher Hampson
- Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, VT
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21
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Andrade-Alegre R, Garisto JD, Zebede S. Open thoracotomy and decortication for chronic empyema. Clinics (Sao Paulo) 2008; 63:789-93. [PMID: 19061002 PMCID: PMC2664280 DOI: 10.1590/s1807-59322008000600014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/08/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Traditionally, chronic empyema has been treated by thoracotomy and decortication. Some recent reports have claimed similar clinical results for videothoracoscopy, but with less morbidity and mortality than open procedures. Our experience with thoracotomy and decortication is reviewed so that the results of this surgical procedure can be adequately evaluated. MATERIALS AND METHODS From March 1992 to June 2006, 85 patients diagnosed with empyema were treated at Santo Tomás Hospital by the first author. Diagnosis of chronic empyema was based on the duration of signs and symptoms before definitive treatment and imaging findings, such as constriction of the lungs and the thoracic cage. Thirty-three patients fulfilled the criteria for chronic empyema and underwent open thoracotomy and decortication. RESULTS Twenty-seven patients (81.8 %) were male and the average age of the study group was 34 years. The etiology was pneumonia in 26 patients (78.8%) and trauma in 7 (21.2%). The duration of symptoms and signs before definitive treatment averaged 37 days. All patients had chronic empyema, as confirmed by imaging studies and operative findings. Surgery lasted an average of 139 min. There were 3 (9%) complications with no mortality. The post-operative length of stay averaged 10 days. There were no recurrences of empyema. CONCLUSIONS Open thoracotomy and decortication can be achieved with low morbidity and mortality. Long-term functional results are especially promising. We suggest that the validation of other surgical approaches should be based on comparative, prospective and controlled studies.
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