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The place of thoracostomy - thoracoplasty in the management of chronic pleural empyema

F. Lamouime, M.Rhaouti, H.Harmouchi, Maha Tachaouine, M.Lakranbi, Y Ouadnouni, M Smahi.

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Introduction. — The occurrence of empyema following a pneumonectomy or a chronic pleural pocket is a severe complication of which management is long and difficult. The authors report their experience managing this complication including infection control by an emptying of the pleural pocket through percutaneous drainage or through a thoracostomy which will be coupled with a thoracoplasty to completely erase the pleural pocket.
Materials and methods. — This is a retrospective study conducted between 2009 and 2019 concerning the records of 14 patients treated for empyema whether in the aftermath of a lung resection or as part of a chronic calcified pleural pocket.
Results. — All 14 patients included in the study were male patients aged 21 to 66 years. 6 of which presented a pyothorax complicating a pneumonectomy. 3 cases presented a post-upper lobectomy pyothorax. For the other 5 patients, there was a post-tuberculous chronic calcified pleural pocket, for which attempts of decortication seemed impossible. We observed in total, 6 cases of bronchopleural fistula. All patients had received evacuation of the contents of the pleural through either percutaneous drainage or a thoracostomy in preparation for a possible filling thoracoplasty. The evolution of pleural cavities following thoracotomy was favourable on the septic map leading to a retraction of the pleural cavity and its spontaneous closure in 4 patients. In 8 patients, thoracoplasty was necessary. Postoperative and long-term evolution was satisfactory in all patients and no deaths were recorded in connection with this technique.
Conclusion. — Pyothorax complicating a pneumonectomy cavity and calcified pleural pockets are a serious complication of which the management is long and delicate. The use of thoracic myoplasty is an effective alternative to the filling of the cavity in fragile patients with significant operative risk.

Key words: thoracoplasty, thoracostomy, chronic pleural empyema

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