Decortications through Video-Assisted Thoracoscopic Surgery and Open Thoracotomy in Empyema Thoracis: A Retrospective Study

Background: Empyema Thoracis, a condition in which purulent fluid accumulates within the pleural cavity, is commonly caused by bacterial infection (both Gram-positive and Gram-negative), such as Mycobacterium tuberculosis, and rarely by fungal infection. Timely intervention significantly reduces morbidity and mortality. Surgical intervention is needed in advanced disease. An early intervention can reduce the morbidity and mortality of the patient as well as the financial burden the disease entails. This study aimed to evaluate decortications performed through video-assisted thoracoscopic surgery (VATS) and open thoracotomy.

Methods: This retrospective study included 47 patients who underwent decortications by either VATS or open thoracotomy for empyema Thoracis at the Department of Surgery of, BLDE DU Shri B M Patil Medical College from May 2015 to August 2020.

Results: Tuberculosis was the most common etiological factor for empyema Thoracis. In 19 patients who underwent VATS decortications, VATS was converted to open thoracotomy in 11 patients. Only 8 patients achieved successful decortication with VATS. Thirty- nine patients (including 11 whose VATS was converted to open thoracotomy) underwent successful open thoracotomy decortications. Thirty-two patients had postoperative bronchopleural fistula, and all cases were successfully managed conservatively. The timing of the surgical intervention is critical in reducing morbidity and mortality. The more advanced the disease, the higher the failure rate of VATS in attaining complete decortications.

Conclusion: Empyema Thoracis can affect patients of all age groups, with the peak incidence in the fourth decade. Tuberculosis is a common etiological factor in our region. Open thoracotomy decortication remains the gold standard in attaining complete decortications in advanced Empyema Thoracis.