Video-Thoracoscopic and Open Surgical Management of Thoracic Empyema

Abstract

Background: Thoracic empyema is a severe complication of pleural infection that is still an important clinical challenge even today due to the advances made in imaging and antibiotic therapy. Surgical intervention becomes mandatory when conservative measures fail. Objective: To compare the outcomes of video-thoracoscopic and open surgical management of empyema in different stages. Methodology: A retrospective observational study was conducted at Liaquat National hospital, Karachi, from January 2020 to December 2022. The study included a total of 110 patients who were diagnosed with thoracic empyema and were managed surgically. Patients were stratified into VATS (n = 60) and thoracotomy (n = 50) groups according to the stage of disease and clinical assessment. Data collected included demographics, disease characteristics, operative details, postoperative complications, hospital stay, and long-term outcomes. Results: In comparison to the thoracotomy group, patients subjected to VATS exhibited statistically significant shorter symptom duration, less operative time (85min vs. 130 min), less intraoperative blood loss (150 ml vs. 300 ml), reduced ICU requirement (6.7% vs. 30%), and shorter hospital stay (6.2 vs. 10.5 days).  Recovery of lung function and recurrence rate were comparable in both groups. Conclusion: VATS is a less invasive and effective treatment option for early-stage thoracic empyema, thus leading to favorable perioperative and recovery outcomes. Nevertheless, open thoracotomy remains the standard approach for Stage III or complex empyema. Accurate disease staging and timely surgical intervention are essential for guiding optimal treatment and enhancing patient outcomes.