The Efficacy of VATS and Intrapleural Fibrinolytic Therapy in Parapneumonic Empyema Treatment

Ann Thorac Cardiovasc Surg. 2018 Feb 20;24(1):19-24. doi: 10.5761/atcs.oa.17-00153. Epub 2018 Jan 17.

Abstract

Background: Development of multiloculation-septation is a challenging entity in empyema patients. In this study, it is aimed to investigate the success rates of videothoracoscopic deloculation (VATS-D) and intrapleural fibrinolytic (IPFib) application after tube thoracostomy.

Methods: The study retrospectively examined the patients diagnosed with empyema with multiloculation and septation between January 2005 and December 2014. Among these patients, the study included those who received VATS-D or IPFib therapy.

Results: VATS-D (Group 1) was applied to 54 patients and IPFib (Group 2) was applied to 24 patients. The success of both procedures was evaluated considering the need of decortication in the following periods. In the VATS-D group, 4 (7.4%) patients required decortication via thoracotomy where it was 1 (4.1%) patient (p = 0.577) in the IPFib group. The length of hospital stay was 6.81 ± 2.55 (4-15) days in Group 1 compared to 14.25 ± 6.44 (7-27) days in Group 2 (p <0.001).

Conclusions: It was demonstrated that both of the methods applied in the study have high efficacy and are preferable methods based on the general conditions of patients. Additionally, the shorter length of hospital stays in patients received VATS-D was established as a significant parameter.

Keywords: empyema; fibrinolytic therapy; operation; videothoracoscopy.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chest Tubes
  • Empyema, Pleural / diagnostic imaging
  • Empyema, Pleural / therapy*
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Pleural Effusion / diagnostic imaging
  • Pleural Effusion / therapy*
  • Retrospective Studies
  • Risk Factors
  • Streptokinase / administration & dosage*
  • Streptokinase / adverse effects
  • Thoracic Surgery, Video-Assisted* / adverse effects
  • Thoracostomy / instrumentation
  • Thoracotomy
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / methods*
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Young Adult

Substances

  • Fibrinolytic Agents
  • Streptokinase