Post-pneumonectomy empyema

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Abstract
Empyema remains a formidable complication following pneumonectomy, andcompounds the mortality of such major surgery. Our experience of 41 casesof post-pneumonectomy empyema (PPE) is presented. There is no universallyappropriate treatment and management depends upon the patient's generalcondition and the presence of associated fistulas. Initial managementconsists of drainage in all cases. This may be continued if the patient isunfit for further procedures or if there is any doubt about the possibilityof an early relapse. Since 1979, we have treated 23 cases of PPE notassociated with bronchopleural fistula (BPF) ("simple" PPE). All weretreated by rib resection and open drainage. Subsequently in four patients,Portovac drainage eradicated the space and infection within 3 and 12months. One patient died of pulmonary embolus one day after open drainage.Three patients were unfit for further treatment and one patient refusedfurther treatment. One patient underwent Schede thoracoplasty and had nofurther infection. Thirteen patients were re-admitted after a period ofopen tube drainage (3-28 weeks), the infected space was irrigated tosterility and closed. This was successful in eight cases which haveremained sterile 9 months to 9 years later. Five patients developedrecurrent PPE and three patients have remained sterile following repeatedirrigation and closure. The management of PPE is further complicated byconcurrent fistulas. Since 1979, 18 patients have had PPE complicated byfistula ("complex" PPE), often recurrent following previous unsuccessfulattempts at closure. Treatment has been individualized, and has oftenrequired further major surgery. Small BPFs closed with drainage and thespace was obliterated with Portovac drainage in three patients.(ABSTRACTTRUNCATED AT 250 WORDS)

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