JTPM
Journal of Translational and Practical Medicine

Journal of Translational and Practical Medicine regularly publishes internationally qualified issues in the field of Medicine in the light of up-to-date information.

eISSN: 2822-5082
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
The effects of etiological factors on timing of decortication
Abstract
Aim: Tube drainage is the primary method in the treatment of empyema with 80-90% cure rates. In patients with empyema who have not received adequate treatment, the result is pleural fibrosis. Decortication is the only treatment option for chronic empyema that has caused fibrothorax that prevents lung expansion. In our study, we aimed to determine the relations between etiological base of the disease, the consequences and the decision of decortication timing. Methods: The patients who were admitted and hospitalized with pleural effusion between 1994 and 2000 were included in the study. We examined the duration of pretreatment, pleural thickness and the duration of postoperative hospital stay of these cases, with who have undergone decortication surgery. Results: A total of 82 cases of decortication were enrolled, which consisted of 61 male (74.3%) and 21 female (25.6%). The cases were examined in two groups: tuberculosis [12 (25%) empyema, 27 (56.3%) tuberculous pachypleuritis, 9 (18.8%) pleurisy + parenchymal involvement] and non-tuberculosis [2 (5.9%) trauma, 5 (14.7%) pneumonia + empyema, 23 (%) 67.6% empyema, 4 (11.8%) hydatid cyst]. The effects of preoperative treatment durations on the thickness of the decortication materials and the duration of postoperative hospital stay were investigated. The preoperative treatment period of the tuberculosis group was significantly higher, the decortication pleural thicknesses were found to be greater. (p<0.01) There was no statistically significant difference in the duration of postoperative hospital stay between the tuberculosis and other group (p>0.05). Conclusion: In cases that do not respond to closed tube drainage and appropriate antibiotic therapy, decortication should be performed without delay considering the etiological factors. If decortication is performed earlier than 2 weeks, the visceral pleura can be easily separated; parietal decortication is rarely needed which might be an advantage of the procedure.

Keywords : Tuberculosis, empyema, decortication, pleural thickness

Download Article


1. Takasugi JE, Godwin JD, Teefey SA. The extrapleural fat inempyema: CT appearance. Br J Radiol. 1991;64(763):580-583.doi:10.1259/0007-1285-64-763-580
2. Kaplan DK. Treatment of empyema thoracis. Thorax.1994;49(9):845-846. doi:10.1136/thx.49.9.845
3. Neff CC, vanSonnenberg E, Lawson DW, Patton AS. CT follow-up of empyemas: pleural peels resolve after percutaneouscatheter drainage. Radiology. 1990;176(1):195-197. doi:10.1148/radiology.176.1.2353091
4. Chan CH, Arnold M, Chan CY, Mak TW, Hoheisel GB. Clinicaland pathological features of tuberculous pleural effusion andits long-term consequences. Respiration. 1991;58(3-4):171-175.doi:10.1159/000195921
5. Rizalar R, Somuncu S, Bernay F, Arit&uuml;rk E, G&uuml;naydin M,G&uuml;rses N. Postpneumonic empyema in children treated byearly decortication. Eur J Pediatr Surg. 1997;7(3):135-137.doi:10.1055/s-2008-1071073
6. Weissberg D, Refaely Y. Pleural empyema: 24-year experience.Ann Thorac Surg. 1996;62(4):1026-1029. doi:10.1016/0003-4975(96)00494-8
7. Mouroux J, Maalouf J, Padovani B, Rotomondo C, RichelmeH. Surgical management of pleuropulmonary tuberculosis. JThorac Cardiovasc Surg. 1996;111(3):662-670. doi:10.1016/s0022-5223(96)70320-3
8. Massard G, Roug&eacute; C, Wihlm JM, et al. Decortication is a valuableoption for late empyema after collapse therapy. Ann Thorac Surg.1995;60(4):888-895. doi:10.1016/0003-4975(95)00541-r
9. Suzuki T, Kitami A, Suzuki S, Kamio Y, Narushima M, SuzukiH. Video-assisted thoracoscopic sterilization for exacerbationof chronic empyema thoracis. Chest. 2001;119(1):277-280.doi:10.1378/chest.119.1.277
10. &Ccedil;elik M, Şenol C, Halezaroğlu S, Uysal A, Zonuzi F, Kıral H,Kurutepe M, Saygı A, Arman B. The role of thoracoscopicDebridement and irrigation in treatment of nontuberculousempyema. 4th European Conference on General ThoracicSurgery. 24-26 October, 1996. Cordoba, Spain (AbstractBook).
11. &Ccedil;elik M, Şenol C, Halezaroğlu S, et al. Videothoracoscopicsurgery. Heybeliada Med Bull. 1995;1(3):13-20.
12. Ridley PD, Braimbridge MV. Thoracoscopic debridement andpleural irrigation in the management of empyema thoracis. AnnThorac Surg. 1991;51:461-464.
13. Waller DA, Rengarajan A. Thoracoscopic decortication: a rolefor video-assisted surgery in chronic postpneumonic pleuralempyema. Ann Thorac Surg. 2001;71(6):1813-1816. doi:10.1016/s0003-4975(01)02471-7
14. Angelillo Mackinlay TA, Lyons GA, Chimondeguy DJ, PiedrasMA, Angaramo G, Emery J. VATS debridement versusthoracotomy in the treatment of loculated postpneumoniaempyema. Ann Thorac Surg. 1996;61(6):1626-1630.doi:10.1016/0003-4975(96)00194-4
15. Senol C, Halezaroğlu S, Uysal A, Arman B, Keleş M. Decorticationin infective pleural pathologies. Respiration. 1992;17:201-207.
16. Frikodt Moller PC, Vejlsed H. Early surgical interventionin nonspecific pleural empyema. Thorac Cardiovasc Surg.1985:33(1):41-43.
17. Musket A, Burton NA, Karwande SV, Collins MP. Managementof refractory empyema with early decortication. AM J Surg.1988:156(6):529-532.
18. Coon JL, Shuck JM. Failure of tube thoracostomy for post-traumatic empyema: An indication for early decortication. JTrauma. 1975;15(7):588-594.
19. Murray F, Nadel A. Textbook of Respiratory Medicine, 3rd edd,2000, Vol 2, Tuberculous Pleurisy P:2035-2040.
20. Ali SM, Siddiqui AA, McLaughlin JS. Open drainage of massivetuberculous empyema with progressive reexpansion of the lung:an old concept revisited. Ann Thorac Surg. 1996;62(1):218-224.doi:10.1016/0003-4975(96)00298-6
21. Thourani VH, Brady KM, Mansour KA, Miller JI Jr, Lee RB.Evaluation of treatment modalities for thoracic empyema: a cost-effectiveness analysis. Ann Thorac Surg. 1998;66(4):1121-1127.doi:10.1016/s0003-4975(98)00767-x
22. Patel J, Leger L. Nouveau traite de technique chirurgicale. Massonet Cie, Paris, 3rd ed. Chapter 18, P:401(1973).
23. Sabinston D.C, Spencer F.C. Gibbon&#39;s surgery of the chest. W.B.Saunders Company, Philadelphia, Toronto, 4th ed. (1993) 391-405.
24. Asbaugh DG, F.C.C.P. Empyema Thoracis: Factors influencingmorbidity and mortality. Chest. 1991;99(5):1162-1166.
25. Hood RM. Techniques in General Thoracic Surgery W.B.SaundersCompany Philadelphia-1985. Pleural decortication: P:48-50,Pleura and chest Wall:P:161-165.
26. Banjer A, Alamri S. Bilateral empyema thoracis treated by stagedthoracotomies; Ann Saudi Med. 1999;19.
27. G&ouml;z&uuml; O, &Ouml;zyardımcı N, Sara&ccedil;oğlu İ, Yaman &Ouml;, Fakı İ. Therelationship between the diagnosis and the amount of fluid inpleurisy. Respiration. 1982;7:200.
28. Al-Kattan KM. Management of tuberculous empyema. EurJ Cardiothorac Surg. 2000;17(3):251-254. doi:10.1016/s1010-7940(99)00370-x
29. Mart&iacute;nez MA, Cordero PJ, Cases E, et al. Factores predictivosdel engrosamiento pleural residual en el derrame pleuralmetaneum&oacute;nico. Arch Bronconeumol. 1999;35(3):108-112.doi:10.1016/s0300-2896(15)30287-8
30. Rizzi A, Rocco G, Robustellini M, Rossi G, Della Pona C, MasseraF. Results of surgical management of tuberculosis: experiencein 206 patients undergoing operation. Ann Thorac Surg.1995;59(4):896-900. doi:10.1016/0003-4975(95)00011-9
31. Burford TH, Parker EF, Samson PC. Early pulmonarydecortication in the treatment of posttraumatic empyema. AnnSurg. 1945;122(2):163-190. doi:10.1097/00000658-194508000-00003
32. Mushegera CK, Mbuyi-Muamba JM, Kabemba MJ. Indicationsand results of pleuropulmonary decortications in the universityhospital of Kinshasa. Acta Chir Belg. 1996;96(5):217-222.
Article available in :
Volume 2, Issue 2, 2023
Page : 74-79
https://doi.org/10.51271/JTPM-0045
Article Information
Received : 15 Ağu 2023
Accepted : 31 Ağu 2023
Published : 31 Ağu 2023
Corresponding Author :

Müfide Arzu Özkarafakılı:

[email protected]
Citation : Özkarafakılı MA, Saraç S. The effects of etiological factors on timing of decortication. J Transl Pract Med. 2023;2(2):74-79.

Read: 204
Cited: 0
Download : 110
_Footer