Tuberculous empyema thoracic -surgical perspective

Authors

  • Rizwan Aziz Memon
  • Syed Ali Arsalan
  • Ali Raza Uraizee
  • Jawed Ahmed Memon
  • Aneel Roy Bhagwani
  • Imroz Arif Farhan

Keywords:

Tuberculosis, Empyema thoracic, Decortication, Thoracotomy

Abstract

Objective: To find out the difference in outcome of patients undergoing surgery for tuberculous empyema in early V/S late stages of disease. Subjects and Methods: This is a retrospective study of 163 patients of 20-50 years of age who underwent thoracotomy and decortication for tuberculous empyema thoracic from July 2009 to June 2013. Patients were divided into two groups on the basis of their duration of use of Anti-Tuberculosis Therapy (ATT). Group A (n=80) took ATT for 2 months and Group B (n=83) took ATT for 4 months and above. Age less than 20yrs and above 50yrs, poor functional and nutritional status, underlying parenchymal disease, A.T.T. Defaulters and MDR T.B were excluded. Results: There was no mortality in Group A, while 1 mortality occurred in Group B. Mean day of discharge was 5th post-operative day in Group A and 6th in Group B. 7 patients from Group A and 13 patients from Group B had wound complications whereas 5 patients from Group A and 12 from Group B required up to 10 day of hospitalization due to prolonged air leaks. 1 patient from Group B required revision of procedure and ended up with pleurocutaneous window. Conclusion: Operating patients early with T.B Empyema Thoracic carries better results if compared to those operated at a later stage. Patient selection is an important factor. Key to success is adequate intake of A.T.T. dose by the patients

References

Hsieh M J, Liu YH, Chao YK, Lu MS, Liu HP, Wu YC, et all. Risk factors in surgical management of thoracic empyema in elderly patients. ANZ J. Surg. 2008; 78: 445-8. doi: 10.1111/j.1445-2197.2008.04532.x

Malhotra P, Aggarwal AN, Agarwal R, Ray P, Gupta D, Jindal SK. Clinical characteristics and outcome of empyema thoracis in 117 patients. A comparative analysis of tubercular vs. non tubercular aetiologies. Respir Med. 2007; 101:423-30.

Fallon WF Jr. Post-traumatic empyema. J. Am. Coll. Surg. 1994; 179: 483-92.

Acharya PR, Shah KV. Empyema thoracis: A clinical study. Ann Thorac Med. 2007 Jan-Mar; 2(1): 14-7.

Acharya PR, Shah KV. Empyema thoracis: A clinical study. Ann Thorac Med [serial online] 2007 [cited

Oct 14]; 2:14-7. Available : http://www.thoracicmedicine.org/text.asp?2007/2/ 1/14/30356.

Light RW. Parapneumonic effusions and empyema. Proc. Am Thorac Soc 2006;3: 75-80

Empyema DS, Seaton A, Seaton D, Leitch AG, editors. Crofton and Douglas's respiratory diseases. 5th ed. Oxford: Blackwell Science Ltd; 2000. pp. 445-58.

Eldin A, Ahmed H, Yacoub TE. Empyema Thoracis. Clin Med Insights Circ Respir Pulm Med. 2010; 4: 1-8.

Choi SS, Kim DJ, Kim KD, Chung KY. Change in pulmonary function following empyemectomy and decortication in tuberculous and non-tuberculous chronic empyema thoracis. Yonsei Med J. 2004;45(4):643-8.

Gokce M, Okur E, Baysungur V, Ergene G, Sevilgen G, Halezeroglu S. Lung decortication for chronic empyema: effects on pulmonary function and thoracic asymmetry in the late period. Eur J Cardiothorac S u r g . 2 0 0 9 ; 3 6 ( 4 ) : 7 5 4 - 8 . d o i : 10.1016/j.ejcts.2009.04.043.

Sihoe AD, Shiraishi Y, Yew WW. The current role of thoracic surgery in tuberculosis management. Respirology.2009;14(7):954-68. d o i : 1 0 . 1111 / j . 1 4 4 0 1 8 4 3 . 2 0 0 9 . 0 1 6 0 9 . x .

Banga A, Khilnani GC, Sharma SK, Dey AB, Wig N, Banga N. A study of empyema thoracis and role of intrapleural streptokinase in its management. BMC Infect Dis. 2004 ; 4:19-22

Casali C, Storelli ES, Di Prima E, Morandi U. Long-term functional results after surgical treatment of parapneumonic thoracic empyema. Interact Cardiovasc Thorac Surg. 2009 (1):74-8. doi: 10.1510/icvts.2009.203190.

Shahin Y, Duffy J, Beggs D, Black E, Majewski A. Surgical management of primary empyema of the pleural cavity: outcome of 81 patients. Interact Cardiovasc Thorac Surg. 2010; 10(4):565-7. doi: 10.1510/icvts.2009.215004.

Brims F.J.H, Lansley S.M, Waterer G.W, Lee Y.C.G. Empyema thoracis: new insights into an old disease. E u r R e s p i r R e v 2 0 1 0 ; 1 9 : 2 2 0 - 8 DOI:10.1183/09059180.00005610

Bilgin M, Akcali Y, Oguzkaya F. Benefits of early aggressive management of empyema thoracis. ANZ J. Surg. 2006; 76: 120-2. doi: 10.1111/j.1445-2197.2006.03666.x

Marks DJ1, Fisk MD, Koo CY, Pavlou M, Peck L, Lee SF et al. Thoracic Empyema: A 12-Year Study from a UK Tertiary Cardiothoracic Referral Centre. PLoSOne. 2 0 1 2 ; 7 ( 1 ) : e 3 0 0 7 4 . d o i : 10.1371/journal. pone. 0030074.

Lee SF, Lawrence D, Booth H, Morris-Jones S, Macrae B. Thoracic empyema: current opinions in medical and surgical management. Curr Opin Pulm Med. 2010; 16:194-200.

Christopoulou-Aletra H, Papavramidou N. "Empyemas" of the thoracic cavity in the Hippocratic Corpus. Ann Thorac Surg 2008; 85: 1132-4.

Freixinet J, Rivas J J, Rodríguez de Castro F, Caminero JA, Rodríguez P, Serra M et al. Role of surgery in pulmonary tuberculosis. Med Sci Monit, 2002; 8(12): CR782-6

Chen W, Lin YC, Liang SJ, Tu CY, Chen HJ. Hospital-acquired thoracic empyema in adults: a 5- year study. South Med J. 2009; 102: 909-14.

Liang SJ, Chen W, Lin YC, Tu CY, Chen HJ. Community-acquired thoracic empyema in young adults. South Med J 2007; 100: 1075-80.

Uraizee AR, Memon JA, Bhagwani AR, Poonawala AA, Farhan IA, Husain SA. Tuberculous empyema thoracis surgical perspective. A tertiary care center experience. Eur Respir J 2011; 38:453-7

Pomeranz M, Brown JM: Surgery in the treatment of multidrug-resistant tuberculosis. Clin Chest Med, 1997; 18: 123-30

Ferguson AD, Prescott RJ, Selkon JB, Watson D, Swinburn CR The clinical course and management of thoracic empyema. QJM 1996; 89: 285-9

Downloads

Published

2014-06-02

How to Cite

Memon, R. A. ., Arsalan, S. A. ., Uraizee, . A. R. ., Memon, . J. A. ., Bhagwani, . A. R. ., & Farhan, I. A. . (2014). Tuberculous empyema thoracic -surgical perspective. Journal of Bahria University Medical and Dental College, 4(1), 12–15. Retrieved from https://jbumdc.bahria.edu.pk/index.php/ojs/article/view/72

Issue

Vol. 4 No. 1 (2014): Volume 4 Issue 1

Section

Original Articles

License

Copyright (c) 2014 Rizwan Aziz Memon, Syed Ali Arsalan, Ali Raza Uraizee, Jawed Ahmed Memon, Aneel Roy Bhagwani, Imroz Arif Farhan

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0