Efficacy Of Video Assisted Thoracoscopic Surgery Versus Tube Thorocostomy In The Management Of Empyema Thoracis

Abstract

Background and objectives: Empyema thoracis is a condition where pus collects in the pleural cavity which occurs most commonly as a reaction to underlying pneumonia. Empyema progresses through 3 stages like exudative, fibrinopurulent and organized stage. Although various treatment modalities have been described, the optimal modality and the better timing for surgical intervention remains controversial. Though tube thorocostomy appears as simple intervention, Video assisted thoracoscopic surgery has a better outcome in treatment of empyema with regarding to morbidity. VATS also has other advantages like being minimally invasive, can provide visualization of thoracic cavity, assist in pleural biopsy and can also treat advanced stages of empyema thoracis. The present study was done to evaluate the efficacy of video assisted thoracoscopic surgery versus tube thorocostomy in treatment of empyema thoracis with regarding to duration of postoperative hospital stay, duration of chest tube insitu, treatment failure, cost of treatment and mortality.

Methodology The prospective comparative study was conducted in the Department of General surgery, BLDEU‟S Shri B.M Patil medical college, hospital and research centre, Vijayapur from October 2014 to September 2016. A total of 60 patients diagnosed to have Empyema thoracis were divided into 2 groups of 30 each ,based on the treatment modality received which includes tube thorocostomy and video assisted thoracoscopic surgery. The efficacy of the treatment were evaluated. xiii Results In the present study, majority of the patients had duration of symptoms with in 7-14 days. The mean duration of chest tube insitu and cost of treatment were less in VATS group (9 days and 12,726 Rs respectively) compared to ICD group (13.3 days and 17,533Rs respectively )which was statistically significant. The mean duration of postoperative hospital stay was less by 2.2 days in VATS group. Total of 2 cases in VATS group and 1 in ICD group were converted to open thoracotomy and 2 mortality were noted in ICD group.

Conclusion Video assisted thoracoscopic surgery is a minimally invasive procedure with good therapeutic results with reduced morbidity and hospitalization. VATS should be considered as primary modality of treatment in Empyema thoracis, Routine use of VATS in early stages of empyema appears to be more efficacious with added advantage of visualization of thoracic cavity to identify other pathology, for staging empyema and also for pleural biopsy.