Surgical treatment of postpneumonic empyema

Postpneumonic empyema complicates 5% of ail pneumonia cases. The loculated fibrinopurulent stage cannot be resolved by drainage tube insertion alone; it requires a debriding limited thoracotomy. Recent reports of series seem to indicate that video-assisted thoracic surgery (VATS) can replace thoracotomy advantageously. Eighty-six cases of postpneumonic empyema were operated on in our institution during the last 12 years: 33 cases (group I) using limited thoracotomy (1985-1991) and 53 by VATS (1992-1996). Data were collected prospectively for group II and retrospectively for the first group. The two populations were comparable in age, gender, stage of disease, and co-morbid status. There were no significant differences between the groups. VATS debridement for loculated fibrinopurulent postpneumonic empyema offers better results than thoracotomy in terms of resolution of the disease and length of stay in hospital. It also seems to be more advantageous, resulting in fewer surgical sequelae, lower cost, less labor impediment, and better cosmesis.