What place for the thoracostomy-thoracmyoplasty in the management of the chronic pleural empyema?

• Published in: Revue de pneumologie clinique Vol. 72; no. 6; pp. 333 - 339
• Main Authors: Lakranbi, M, Rabiou, S, Belliraj, L, Issoufou, I, Ammor, F Z, Ghalimi, J, Ouadnouni, Y, Smahi, M
• Format: Journal Article
• Language: French
• Published: France 01.12.2016
• Subjects: Adult; Aged; Chronic Disease; Empyema, Pleural - surgery; Female; Humans; Male; Middle Aged; Postoperative Complications - etiology; Retrospective Studies; Thoracoplasty - adverse effects; Thoracoplasty - methods; Thoracoplasty - utilization; Thoracostomy - adverse effects; Thoracostomy - methods; Thoracostomy - utilization; Thoracotomy - adverse effects; Thoracotomy - methods; Thoracotomy - utilization; Pyothorax; Thoracostomie; Thoracostomy; Tuberculosis; Lung resection; Resection pulmonaire; Empyema; Tuberculose; Thoracomyoplastie; Thoracomyoplasty
• ISSN: 0761-8417
• DOI: 10.1016/j.pneumo.2016.08.004

The occurrence of empyema after pneumonectomy or in suites with chronic pleural pocket is a dreaded complication. The management is long and difficult. The authors report their experience before this complication including infection control by an emptying of the pleural pocket percutaneous drainage or thoracostomy which will be complemented by a thoracomyoplasty the aim to erase the pleural pocket. This is a retrospective study conducted between 2009 and 2015 concerning the records of 9 patients treated for empyema or in the aftermath of a lung resection or as part of a chronic pleural pocket and calcific. We had identified all 9 male patients aged 30 to 67 years. This was pyothorax complicating pneumonectomy in 4 patients and 1 pyothorax after a left upper lobectomy in 1 case. For the other 4 patients, there was a post-tuberculous pleural pocket, calcified chronic and whose attempts to decortication seemed impossible. We observed 3 cases of bronchopleural fistula. All patients had received evacuation of the contents of the pleural drainage bag is either thoracostomy laying the bed of a possible filling thoracomyoplasty. The evolution of pleural cavities after thoracostomy was favorable on septic map leading to a retraction of the pleural cavity and its spontaneous closure in 1 patient. In 6 patients, filling the cavity with thoracomyoplasty was necessary. The evolution immediate postoperative was favorable in all patients and no deaths were noted in connection with this technique. Pyothorax on pneumonectomy cavity and chronic pleural calcified pockets are serious complications whose management is long and delicate. The thoracomyoplastie is a real alternative to the filling of the cavity in fragile patients with significant operational risk. The results are satisfactory in the hands of a broken team this technique.