The role of thoracoscopy in management and outcome of stage II thoracic parapneumonic empyema: review of 148 cases

Various methods are available for the management of stage II thoracic parapneumonic empyema (TPE). The aim of this study was to determine the better method for the management of stage II TPE. We conducted a retrospective study on patients with diagnosis of TPE during 2005–2014. Demographic and clinical data of patients were recorded and analyzed. A total of 148 patients (112 males, 36 females) underwent therapeutic procedures for stage II TPE. The most common diagnostic tool for TPE was posteroanterior and lateral chest films. Tube thoracostomy with antibiotic therapy and therapeutic thoracocentesis were the primary treatment in 80 patients, of which 12 responded. One hundred twenty-eight patients underwent video-assisted thoracoscopic surgery (VATS) and 118 of them responded. Thirty patients underwent thoracotomy with breakdown of adhesions and decortications that was successful in 86 % of them. Average hospitalization in tube thoracostomy, thoracotomy, and thoracoscopy groups was 10, 8, and 6 days, respectively. Our study showed the high failure rate of simple drainage as the first procedure for the treatment of thoracic empyema. Moreover, our study showed the association of VATS with shorter duration of hospitalization, reduction in complications and mortality rate, and wound infection in the patients, so VATS may be considered as the first choice in the management of stage II TPE. In addition, decortication can be used in any patient with multiloculated empyema because of its high success rate.