Video Assisted Thoracoscopic Surgery (VATS) versus Conventional Thoracotomy For management of empyema

Empyema in Greek means; pus presence in pleural cavity. The precursor of empyema is bacterial pneumonia and subsequent parapneumonic effusion. Most patients with empyema present with clinical manifestations of bacterial pneumonia including; fever, pleuritic chest pain, cough and dyspnea. Physical findings and presentations may vary depending on the organism and duration of illness. Chest radiography, ultrasonography (US), computerized topography (CT) and pleural fluid analysis are the most important investigations. Pleural fluid analysis is important to confirm an empyema rather simple pleural effusion by the glucose, lactate dehydrogenase (LDH), protein level and PH. The aim of treatment in patients with empyema is to save lives, eliminate empyema, re-expand the trapped lung, restore mobility of the chest wall and diaphragm, return of respiratory function to normal, prevent complications or chronicity and reduce the duration of hospital stay. The pursuit of this aim has led to development of multiple therapeutic options including; repeated thoracocentesis closed tube thoracostomy, image directed inta-pleural catheter drainage, intra-pleural fibrinolytic therapy, VATS decortication, mini thoracotomy and standard thoracotomy with decortication.