Professional paper

Surgery treatment of pleural empyema with minimally invasive method at the Thoracic Surgery Department in Zadar General Hospital

Ivan Bačić orcid.org/0000-0002-0422-3485 ; Opća bolnica Zadar, Služba za kirurgiju, Odsjek za torakalnu kirurgiju
Domagoj Morović ; Opća bolnica Zadar, Služba za kirurgiju, Odsjek za torakalnu kirurgiju
Nina Sulen ; Opća bolnica Zadar, Odjel za anesteziologiju, reanimatologiju i intenzivno liječenje
Barbara Petani orcid.org/0000-0002-1509-755X ; Opća bolnica Zadar, Odjel za anesteziologiju, reanimatologiju i intenzivno liječenje
Ivan Kovačić ; Opća bolnica Zadar, Služba za kirurgiju
Željko Čulina ; Opća bolnica Zadar, Služba za internu, Odjel za plućne bolesti
Sonja Bačić Požgaj ; Dom zdravlja Primorsko-goranske županije, Ispostava Opatija

Abstract

VATS ("video assisted thoracoscopic surgery"- is a decortication method of choice in treating pleural empyema in the 2nd phase (fibrinopurulent phase). The preference is a minimally invasive technique in the already exhausted patient when other treatment methods have failed. Thoracoscopic surgery is most often successful when empyema lasts for about 3 weeks. When empyema lasts longer than 3 weeks, the possibility of performing lung decortation with this method is quite more difficult due to firm adhesions that envelops the lungs and a firm cordis. In such a situation, the conversion to thoracotomy may be inevitable in order to complete the surgery.
In the period from January 1, 2012, to December 31, 2013, at the Thoracic Surgery Department of Zadar General Hospital surgery was performed on 32 patients with pleural empyema. The indication for surgery treatment was pleural empyema where other methods of treatment (antibiotics, chest drainage) had failed.
Among the 32 patients that had undergone surgery, the minimally invasive method was performed in 17 patients while "muscle sparing" thoracotomy was performed in 15 patients. Two of the surgeries started with the minimally invasive method but ended in thoracotomy.
There were no fatal outcomes with patients that had undergone VATS decortication and there were no perioperative complications. The average drainage duration was 3 days (2-4). The average hospitalization period was 5 days (4-8). There were no significant complications and no fatal outcomes with patients that had undergone classical surgery. The average hospitalization period with this group of patients was 9 days (7-14), and average drainage duration was 4 days (3-6).
VATS lung decortication has been proved successful in treating pleural empyema. The time that elapses from the beginning of the disease up to thoracic surgery treatment is the most reliable predictor of VATS decortications success. The principles of open decortication are to be followed even with the minimally invasive method. VATS decortication is considered to be successful when the entire content from the chest cavity has been removed, fissures opened, lungs free of adhesions on the diaphragm and the chest wall and lungs fully expanded. The success percentage is high and the drainage duration, hospitalization duration, postoperative pain and recovery have improved with regard to the open method.

Keywords

VATS; pleural empyema; lung decortication

Hrčak ID:

143626

URI

https://hrcak.srce.hr/143626

Publication date:

17.8.2015.

Article data in other languages: croatian

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