Clagett open-window thoracostomy in patients with empyema who had and had not undergone pneumonectomy

• Published in: Canadian journal of surgery Vol. 30; no. 5; p. 329
• Main Authors: Bayes, A J, Wilson, J A, Chiu, R C, Errett, L E, Hedderich, G, Munro, D D
• Format: Journal Article
• Language: English
• Published: Canada 01.09.1987
• Subjects: Aged; Bronchial Fistula - surgery; Empyema - etiology; Empyema - surgery; Female; Fistula - etiology; Fistula - surgery; Follow-Up Studies; Humans; Male; Middle Aged; Pleural Diseases - etiology; Pleural Diseases - surgery; Pneumonectomy - adverse effects; Retrospective Studies; Thoracostomy - methods
• ISSN: 0008-428X; 1488-2310

Patients with empyema not responding to simple chest-tube drainage and antibiotic therapy have been managed by a "Clagett"-type procedure that consists of open-window thoracostomy, antibiotic irrigation and closure of the window. The results of such treatment were reviewed. Of the 103 patients with empyema treated between 1967 and 1983, 41 underwent open-window thoracostomy. Twenty-eight (group 1) had empyema after pneumonectomy, 13 (group 2) did not; however, 9 of the 13 in group 2 had undergone lobectomy. The mean follow-up was 46 months for group 1 and 42 months for group 2. When surgical closure of the open-window thoracostomy was attempted, the success rate in group 1 was 85% for those without concomitant bronchopleural fistula, but only 36% in patients with a fistula. In group 2 the respective success rates were 50% and 57%. Unsuccessful closure resulted in chronic fistulas in four patients in each of the two groups. Six deaths in group 1 and two in group 2 were related to the original disease, but one was an operative death. These results demonstrate both the effectiveness and limitations of open-window thoracostomy in the management of these difficult cases.