Abstract:
Background and objectives:
Empyema thoracis is a condition where pus collects in the pleural cavity
which occurs most commonly as a reaction to underlying pneumonia. Empyema
progresses through 3 stages like exudative, fibrinopurulent and organized stage.
Although various treatment modalities have been described, the optimal modality and
the better timing for surgical intervention remains controversial. Though tube
thorocostomy appears as simple intervention, Video assisted thoracoscopic surgery
has a better outcome in treatment of empyema with regarding to morbidity. VATS
also has other advantages like being minimally invasive, can provide visualization of
thoracic cavity, assist in pleural biopsy and can also treat advanced stages of
empyema thoracis.
The present study was done to evaluate the efficacy of video assisted
thoracoscopic surgery versus tube thorocostomy in treatment of empyema thoracis
with regarding to duration of postoperative hospital stay, duration of chest tube insitu,
treatment failure, cost of treatment and mortality.
Methodology
The prospective comparative study was conducted in the Department of
General surgery, BLDEU‟S Shri B.M Patil medical college, hospital and research
centre, Vijayapur from October 2014 to September 2016. A total of 60 patients
diagnosed to have Empyema thoracis were divided into 2 groups of 30 each ,based on
the treatment modality received which includes tube thorocostomy and video assisted
thoracoscopic surgery. The efficacy of the treatment were evaluated.
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Results
In the present study, majority of the patients had duration of symptoms with in 7-14
days. The mean duration of chest tube insitu and cost of treatment were less in
VATS group (9 days and 12,726 Rs respectively) compared to ICD group (13.3 days
and 17,533Rs respectively )which was statistically significant. The mean duration of
postoperative hospital stay was less by 2.2 days in VATS group. Total of 2 cases in
VATS group and 1 in ICD group were converted to open thoracotomy and 2 mortality
were noted in ICD group.
Conclusion
Video assisted thoracoscopic surgery is a minimally invasive procedure with
good therapeutic results with reduced morbidity and hospitalization. VATS should be
considered as primary modality of treatment in Empyema thoracis, Routine use of
VATS in early stages of empyema appears to be more efficacious with added
advantage of visualization of thoracic cavity to identify other pathology, for staging
empyema and also for pleural biopsy.
