Introduction
re-expansion, septic shock, hemorrhage, empyema, fibrous septations, pleural empyema, leaks, sepsis, septic, trauma
PLEURAL EMPYEMA, HEMORRHAGE, EMPYEMA, CAVITY, SEPTIC SHOCK, SEPSIS, COMPLICATIONS
In the last 20 years, a continuous rise in cases and mortality rates have been reported for pleural empyemaThe goal of surgical therapy is complete cleaning of the pleural cavity and re-expansion of the lungs. It is agreed upon that surgical therapy is necessary when adequate irrigation of the pleural cavity via thoracostomy drainage is complicated by fibrous septations, and recent therapy recommendations lean towards earlier surgical interventionExtensive decortication is an integral part of surgical therapy for advanced-stage empyema. However, decortication can come with a variety of complications which can prolong the treatment course and in multimorbid and elderly patients can even be life-threateningTherefore, new treatment methods that minimize surgical trauma while providing source control in patients with pleural empyema are required.Vacuum therapy as a treatment option for pleural empyema was first published in 2006The goal was to reduce surgery-related morbidity and septic complications by minimizing surgical trauma using small incisions and limiting treatment solely to the parts of the lung affected by empyema. Only local debridement and no decortication were performed, with the theory that the frequently seen bacterially triggered septic shock could be reduced or even prevented. Furthermore, we sought to reduce or avoid complications that often accompany extensive decortication, such as hemorrhage and persistent pulmonary air leaks as well as sepsis, with the latter being potentially lethal for older and debilitated patientsIn contrast to conventional VATS with a rigid and straight fiberoptic, where access to the often small and winding parts of the empyema via the drainage channel is not possible without opening the complete pleural cavity, with flexible endoscopy a tool exists with which it is possible to reach all areas of the empyema cavity. This technique has already been validated for the management of anastomotic leakages after gastrointestinal surgeryWe present the method and results for our series of patients treated with this method and carry out a critical analysis of the benefits, drawbacks, and potential usage in different stages of empyema and various degrees of comorbidities. In addition, we compared our data with those of patients treated using conventional VATS or open thoracotomy.