Early thoracoscopic debridement and drainage as definite treatment for pleural empyema.

OBJECTIVE

To report our experience with early thoracoscopic debridement and drainage in the treatment of pleural empyema in the fibrinopurulent or early organising phase.

DESIGN

Prospective open study.

SETTING

District hospital, Germany.

SUBJECTS

10 Patients operated on between August 1991 and April 1993.

INTERVENTIONS

Double lumen intubation, followed by thoracoscopic opening of the empyema, evacuation of all pus under vision, debridement of the lung, irrigation of the thoracic cavity and insertion of a chest drain.

MAIN OUTCOME MEASURES

Morbidity and mortality.

RESULTS

Cultures taken during the operation grew no pathogens in five cases; Streptococcus pneumoniae, and haemolytic streptococci (once in combination with Staphylococcus aureus), were cultured in two cases each; and Mycobacterium tuberculosis in one. Chest drains were removed a mean of 8.5 days after operation. All patients were well without signs of infection 1-21 months later, and in no case was conversion to open operation necessary.

CONCLUSION

Early thoracoscopic debridement and drainage is a safe and effective alternative to open treatment of patients with pleural empyema in the fibrinopurulent or early organising phase.