F-067TREATMENT OF CHRONIC EMPYEMA USING A LAPAROSCOPICALLY PREPARED OMENTAL PEDICLED FLAP

• Published in: Interactive cardiovascular and thoracic surgery Vol. 18; no. suppl_1; pp. S17 - S18
• Main Authors: Ishibashi, Hironori, Ui, A., Asakawa, A., Seto, K., Wakejima, R., Kobayashi, M., Okubo, K.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.06.2014
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu167.67

Objectives: Thoracic surgeons find it is challenging to treat chronic empyema. Herein, we report our less invasive omental pedicled flap procedure for the management of chronic empyema. Methods: Intrathoracic debridement and filling with a laparoscopically prepared omental flap were performed in patients who had undergone open window thoracostomy for bronchopleural fistula or chronic empyema. The abdominal procedures were conducted through four 5-mm operating ports. Omental flaps were developed by separation from the transverse colon by division of some anastomosing arteries between gastroepiploic vessels and Barkow's arcade. Thoracic transposition of the omentum was achieved through a 3-cm diaphragmatic incision. Results: Between 2011 and 2013, four patients (all male; mean age, 66.8 years) underwent omentoplasty, of whom three had bronchopleural fistulas after lobectomy, and one had empyema due to methicillin-resistant Staphylococcus aureus. All patients underwent open window thoracostomy and achieved closure of the thorax using laparoscopic omentoplasty after infection control. The mean operative time was 221 min (range 170-300 min), and the mean blood loss was 30 ml (range 10-100 ml). The postoperative course was uneventful. Oral intake resumed from Day 2, and the chest drain was removed on Day 2 in all of the patients. The mean postoperative hospital stay was 11 days (range 9-14 days). Conclusions: Laparoscopic omentoplasty entails several advantages for the treatment of empyema. Minimally invasive techniques may widen the indications for the use of the omentum in the treatment of empyema. Disclosure: No significant relationships.