Treatment of Persistent Postpneumonectomy Empyema by Vacuum-Assisted Management: An Analysis of Nine Patients

Abstract

Background Conventional treatment methods in postpneumonectomy empyemas (PPE) are associated with long stay in hospital, poor patient comfort, and high rate of postoperative mortality. Vacuum-assisted management (VAM) may be helpful in solving these problems.

Methods VAM was performed on nine patients with PPE in our clinic between July 2010 and September 2011 to provide continuous drainage of empyema in the pouch and to improve empyema with obliteration of the pouch by accelerating tissue granulation.

Results All nine patients were men (mean age: 54.5 years; range: 18–68 years). Empyema resolution and obliteration of the pouch were achieved with VAM in the cases with empyema without fistula (n = 7) after the pneumonectomy. In the patients with fistula (n = 2), VAM was performed after closure of the fistula. Mean duration of hospital stay was 36.5 (12–57) days. The treatment was successful in eight of nine patients (88.9%). Mean duration of follow-up in the successfully treated patients was 10.9 (3–17) months.

Conclusion Intrathoracic VAM was effective and safe in the treatment of PPE.

Keywords

chest - empyema - surgery - complications

• References

• 1 Goldstraw P. Postpneumonectomy empyema. J R Soc Med 1993; 86 (10) 559-560
• 2 Zaheer S, Allen MS, Cassivi SD , et al. Postpneumonectomy empyema: results after the Clagett procedure. Ann Thorac Surg 2006; 82 (1) 279-286 , discussion 286–287
• 3 García-Yuste M, Ramos G, Duque JL , et al. Open-window thoracostomy and thoracomyoplasty to manage chronic pleural empyema. Ann Thorac Surg 1998; 65 (3) 818-822
• 4 Ditterich D, Rexer M, Rupprecht H. [Vacuum assisted closure in the treatment of pleural empyema — first experiences with intra-thoracal application]. Zentralbl Chir 2006; 131 (Suppl. 01) S133-S138
• 5 Groetzner J, Holzer M, Stockhausen D , et al. Intrathoracic application of vacuum wound therapy following thoracic surgery. Thorac Cardiovasc Surg 2009; 57 (7) 417-420
• 6 Aru GM, Jew NB, Tribble CG, Merrill WH. Intrathoracic vacuum-assisted management of persistent and infected pleural spaces. Ann Thorac Surg 2010; 90 (1) 266-270
• 7 Saadi A, Perentes JY, Gonzalez M , et al. Vacuum-assisted closure device: a useful tool in the management of severe intrathoracic infections. Ann Thorac Surg 2011; 91 (5) 1582-1589
• 8 Palmen M, van Breugel HN, Geskes GG , et al. Open window thoracostomy treatment of empyema is accelerated by vacuum-assisted closure. Ann Thorac Surg 2009; 88 (4) 1131-1136
• 9 Al-Mufarrej F, Margolis M, Tempesta B, Strother E, Gharagozloo F. Outpatient management of post-pneumonectomy and post-lobectomy empyema using the vacuum-assisted closure system. Surg Today 2010; 40 (8) 711-718
• 10 Sziklavari Z, Grosser C, Neu R , et al. Complex pleural empyema can be safely treated with vacuum-assisted closure. J Cardiothorac Surg 2011; 6: 130
• 11 Arnold PG, Pairolero PC. Intrathoracic muscle flaps. An account of their use in the management of 100 consecutive patients. Ann Surg 1990; 211 (6) 656-660 , discussion 660–662
• 12 Sartipy U, Lockowandt U, Gäbel J, Jidéus L, Dellgren G. Cardiac rupture during vacuum-assisted closure therapy. Ann Thorac Surg 2006; 82 (3) 1110-1111