DOI: 10.36347/sjams.2021.v09i04.010

Pages: 541-545

Background: Video-assisted thoracoscopic surgical decortication (VATSD) is widely applicable in fibropurulent (Stage II) pleural empyema. However, there is limited number of existing reports regarding the management of organizing (Stage III) pleural empyema via VATSD. Hence, we evaluated the effectiveness and perioperative clinical outcomes of VATSD in both Stage II and Stage III pleural empyema. Methods: A retrospective review of patients who diagnosed as Stage II and Stage III pleural empyema in Serdang Hospital from June 2018 to June 2019 who underwent VATSD and/or thoracotomy was performed. The perioperative outcomes including surgical effectiveness, duration of postoperative hospital stay, postoperative morbidity and mortality were analysed. Results: Out of total 21 patients, 10(48%) patients had Stage II pleural empyema and 11 patients (52%) had Stage III pleural empyema. The causes of pleural empyema were pneumonia (16, 76%), infection secondary to prolonged tube thoracostomy (2, 10%), undrained hemothorax post chest trauma (2, 10%) and pulmonary tuberculosis (PTB) (1, 4%). All Stage II pleural empyema completed VATSD successfully whereas 9 (43%) patients of Stage III pleural empyema completed VATSD successfully and 2 (10%) patients required conversion to decortication. The surgical effectiveness and postoperative complications treated with VATSD in terms of length of hospital stay, air leak, pain, wound infection, empyema recurrence, and mortality were not statistically different between Stage II and Stage III pleural empyema. Conclusions: VATSD is an effective and safe treatment option for patient with Stage II pleural empyema and feasible in most Stage III pleural empyema with low conversion rate to open decortication.