Comparative Study between Video Assisted Thoracoscopic Decortication versus Conventional Thoracotomy for Chronic Empyema in Adults

doi:10.21608/ejhm.2025.436798

Comparative Study between Video Assisted Thoracoscopic Decortication versus Conventional Thoracotomy for Chronic Empyema in Adults

Document Type : Original Article

10.21608/ejhm.2025.436798

Abstract

Background:Empyema is the presence of purulent material inside the pleural cavity.
Objective: This work aimed to compare the outcomes of video assisted thoracoscopic decortication versus conventional thoracotomy for chronic empyema in adults.
Methods: This prospective randomized comparative clinical study included 40 patients suffering from chronic empyema underwent decortication by video assisted thoracoscopic surgery (VATS) or conventional thoracotomy at the Department of Cardiothoracic Surgery, Tanta University Hospital. Studied cases were randomized into 2 equal groups in a parallel manner by computer generated numbers & their allocation code was kept in a closed opaque envelope: Group A underwent VATS and group B underwent lung decortication via conventional postero-lateral thoracotomy.
Results: Duration of surgery was significantly higher in group A than in group B (P value<0.001). Intraoperative blood loss was significantly lower in group A than in group B (P value<0.05). Hospital stays, visual analogue scale (VAS) were significantly lower in patients in group A than in group B .
Conclusions: VATS offers significant advantages in terms of reducing intraoperative blood loss, blood transfusion requirements, hospital stay, postoperative thoracic drainage, pain score, inflammatory markers, and higher hemoglobin level. Conventional thoracotomy showed reduced operative time and provided effective lung decortication in cases with severe adhesions to achieve the optimum results and to decrease the duration and the complications of the surgery. Sliding score by dynamic CT provided valuable preoperative insights into grade of pleural adhesions, aiding surgical planning and guiding the decision to proceed with VATS or convert to open thoracotomy.

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