Chronic postpneumonic pleural empyema: comparative merits of thoracoscopic versus open decortication.

Objective:We seekto evaluatethecomparativemeritsofthoracoscopicversusopendecorticationinthesurgicalmanagementofpatientswith chronic postpneumonic pleural empyema.Methods:From January 1996 to December 2006, 308 patients (180 males, 128 females, mean age: 56.3 years, range: 17—82 years) with chronic postpneumonic pleural empyema underwent decortication after failure of conservative treatment. Results: Decortication was performed by open thoracotomy in 123 (39.9%) patients (OT) and by videothoracoscopy (VT) in 185 (60.1%). Mortality was 1.29% (4/308). Morbidity was 21.1% (65/308). At 6 months follow-up, three VT patients showed recurrent empyema and underwent re-do surgery by video-assisted-thoracoscopy (VATS) (one patient) or by thoracotomy (two patients). The videothoracoscopic approach showed statistically significant better results in terms of in-hospital postoperative (day 1 and day 7), pain (p < 0.0001), postoperative air leak ( p= 0.004), operative time (p < 0.0001), hospital stay (p = 0.020) and time to return to work (p < 0.0001). The analysis of postoperative pain at 6 monthsfollow-upshowednosignificantdifferencesamongthedifferentgroups.Conclusions:In thelightofourexperience,videothoracoscopic decortication appears to be the surgical treatment of choice for chronic postpneumonic pleural empyema even if a multicentric-randomised trial should be performed before videothoracoscopic decortication becomes the gold standard for the treatment of pleural empyema. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.