Abdul Baseer, Aamir Bilal.
Open decortication for empyema thoracis. an experience of 1341 cases over a 10 year period.
Pak J Chest Med Jan ;20(1):3-7.

Objective: To assess the outcome of surgical management of empyema thoracis in cases treated by open decortication. Methodology: Computerized clinical record of 1341 patients who underwent decortication for empyema thoracic from June 2002 to May 2012 were retrospectively analyzed. Patient of all ages, both sexes and diagnosed empyema thoracis were included. Medically unfit, empyema due to malignant pleural effusion, empyema due to clotted hemothorax were excluded from the study. All patients were admitted through outpatient department. Majority of the cases were referred from pulmonology and medical units. All patients underwent decortication by conventional posterolateral thoracotomy. Follow up done in all cases. Result: Out of 1341 patients, 998 (74.4%) patients were male and 343 (25.5%) were female, age ranges from 2 to 71 years with a mean age of 33.12 years. Bronchopleural fistula was present in 419 (31.24%) patients and empyema necessitans in 141 cases (10.51%). Pneumonia and tuberculosis were seen in 583 (43.4%) and 758 (56.5%) cases respectively. Seven hundred and seventy one cases (57.4%) underwent right thoracotomy and 570 cases (42.50%) left thoracotomy. Mean duration of postoperative chest drain was 14 days. Morbidity is 112 (8.3%) while 23 (1.71%) patients died in this study. Follow-up ranged from 15 days to 6 months. Conclusion: The duration of the disease had a direct relation with the thickness of the pleura and injury to the underlying lung. Delayed referral causes irreversible changes in the lung prolonging recovery and increasing complication rate. Meticulous decortication gives gratifying results. The status of the lung at the end of surgery is a major prognostic indicator.

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