Surgical management of primary empyema of the pleural cavity: outcome of 81 patients.

Postpneumonic empyema is the most common form of empyema thoracis and is still recognised as a major cause of morbidity and prolonged hospital stay. We reviewed 106 patients retrospectively who underwent surgical management of pleural empyema over a period of three years from August 2005. We identified 81 patients (76%) (58 males, mean age 52 years) with primary empyema and 25 patients (24%) with secondary empyema. The first group of patients with primary empyema was analysed. Twenty-nine patients (36%) had stage II empyema and 52 patients (64%) had stage III. The majority of stage II empyema patients underwent thoracoscopic debridement (28 patients) and one patient had open thoracotomy and debridement. Stage III patients underwent thoracoscopic decortication (32 patients) of those six patients (19%) were converted to open decortication, open decortication (19 patients) and fenestration (one patient). Mortality rate was 0% for all procedures. Median length of hospital stay was six days for thoracoscopic debridement, five days for thoracoscopic decortication and eight days for open decortication. Patients treated with video-assisted thoracoscopic surgery (VATS) debridement or decortication spent less time in hospital and the conversion rate to open procedure for stage III empyema was only 19%, which encourages us to consider VATS debridement/decortication as a first choice treatment.