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Prosthesis for open pleurostomy (POP): management for chronic empyemas.

Filomeno LT, Campos JR, Machuca TN, das Neves-Pereira JC, Terra RM - Clinics (Sao Paulo) (2009)

Bottom Line: Forty-four consecutive patients with chronic empyema were treated.The etiology of empyema was diverse: pneumonia, 20; lung resections, 12 (pneumonectomies, 7; lobectomies, 4; non-anatomical, 1); mixed-tuberculous, 6; and mixed-malignant pleural effusion, 6.Lung re-expansion was also successful in 93%, 75%, 33%, and 40% of the groups, respectively Prosthesis for open pleurostomy insertion is a minimally invasive procedure that can be as effective as conventional open pleural window for management of chronic empyemas.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil.

ABSTRACT

Objectives: We developed a prosthesis for open pleurostomy cases where pulmonary decortication is not indicated, or where post-pneumonectomy space infection occurs. The open pleural window procedure not only creates a large hole in the chest wall that is shocking to patients, also results in a permanent deformation of the thorax. prosthesis for open pleurostomy is a self-retained silicone tube that requires the removal of 3 cm of one rib for insertion, and acts as a mature conventional open pleural window. Herein, we report our 13-year experience with this device in the management of different kinds of pleural empyema.

Methods: Forty-four consecutive patients with chronic empyema were treated. The etiology of empyema was diverse: pneumonia, 20; lung resections, 12 (pneumonectomies, 7; lobectomies, 4; non-anatomical, 1); mixed-tuberculous, 6; and mixed-malignant pleural effusion, 6. After debridement of both pleural surfaces, the prosthesis for open pleurostomy was inserted and attached to a small recipient plastic bag.

Results: Infection control was achieved in 20/20 (100%) of the parapneumonic empyemas, in 3/4 (75%) of post-lobectomies, in 6/7 (85%) of post-pneumonectomies, in 6/6 (100%) of mixed-tuberculous cases, and in 4/6 (83%) of mixed-malignant cases. Lung re-expansion was also successful in 93%, 75%, 33%, and 40% of the groups, respectively

Conclusions: Prosthesis for open pleurostomy insertion is a minimally invasive procedure that can be as effective as conventional open pleural window for management of chronic empyemas. Thus, we propose that the use of prosthesis for open pleurostomy should replace the conventional method.

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Related in: MedlinePlus

On the left, a conventional open pleural window scar in a male patient. On the right, the upper scar is after POP removal, and below is a scar after removal of a regular 36FR chest tube
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f4-10-oa-0220: On the left, a conventional open pleural window scar in a male patient. On the right, the upper scar is after POP removal, and below is a scar after removal of a regular 36FR chest tube

Mentions: In the present study, treatment of chronic empyemas with POP provided the same results we used to observe when performing the large OPW, both in terms of infection control and lung re-expansion. The use of this new device, however, offers additional advantages over the conventional operation: 1) insertion takes only about 20 minutes, compared with at least 60 minutes usually necessary to create a large pleurostoma; 2) it can be done under local anesthesia; 3) it does not require multiple postoperative dressings or the close attention of nurses. The main advantage for the patient, however, is that the use of POP precludes major chest wall demolition, thus avoiding gross aesthetic compromise. (Figure 4).


Prosthesis for open pleurostomy (POP): management for chronic empyemas.

Filomeno LT, Campos JR, Machuca TN, das Neves-Pereira JC, Terra RM - Clinics (Sao Paulo) (2009)

On the left, a conventional open pleural window scar in a male patient. On the right, the upper scar is after POP removal, and below is a scar after removal of a regular 36FR chest tube
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2666462&req=5

f4-10-oa-0220: On the left, a conventional open pleural window scar in a male patient. On the right, the upper scar is after POP removal, and below is a scar after removal of a regular 36FR chest tube
Mentions: In the present study, treatment of chronic empyemas with POP provided the same results we used to observe when performing the large OPW, both in terms of infection control and lung re-expansion. The use of this new device, however, offers additional advantages over the conventional operation: 1) insertion takes only about 20 minutes, compared with at least 60 minutes usually necessary to create a large pleurostoma; 2) it can be done under local anesthesia; 3) it does not require multiple postoperative dressings or the close attention of nurses. The main advantage for the patient, however, is that the use of POP precludes major chest wall demolition, thus avoiding gross aesthetic compromise. (Figure 4).

Bottom Line: Forty-four consecutive patients with chronic empyema were treated.The etiology of empyema was diverse: pneumonia, 20; lung resections, 12 (pneumonectomies, 7; lobectomies, 4; non-anatomical, 1); mixed-tuberculous, 6; and mixed-malignant pleural effusion, 6.Lung re-expansion was also successful in 93%, 75%, 33%, and 40% of the groups, respectively Prosthesis for open pleurostomy insertion is a minimally invasive procedure that can be as effective as conventional open pleural window for management of chronic empyemas.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Surgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil.

ABSTRACT

Objectives: We developed a prosthesis for open pleurostomy cases where pulmonary decortication is not indicated, or where post-pneumonectomy space infection occurs. The open pleural window procedure not only creates a large hole in the chest wall that is shocking to patients, also results in a permanent deformation of the thorax. prosthesis for open pleurostomy is a self-retained silicone tube that requires the removal of 3 cm of one rib for insertion, and acts as a mature conventional open pleural window. Herein, we report our 13-year experience with this device in the management of different kinds of pleural empyema.

Methods: Forty-four consecutive patients with chronic empyema were treated. The etiology of empyema was diverse: pneumonia, 20; lung resections, 12 (pneumonectomies, 7; lobectomies, 4; non-anatomical, 1); mixed-tuberculous, 6; and mixed-malignant pleural effusion, 6. After debridement of both pleural surfaces, the prosthesis for open pleurostomy was inserted and attached to a small recipient plastic bag.

Results: Infection control was achieved in 20/20 (100%) of the parapneumonic empyemas, in 3/4 (75%) of post-lobectomies, in 6/7 (85%) of post-pneumonectomies, in 6/6 (100%) of mixed-tuberculous cases, and in 4/6 (83%) of mixed-malignant cases. Lung re-expansion was also successful in 93%, 75%, 33%, and 40% of the groups, respectively

Conclusions: Prosthesis for open pleurostomy insertion is a minimally invasive procedure that can be as effective as conventional open pleural window for management of chronic empyemas. Thus, we propose that the use of prosthesis for open pleurostomy should replace the conventional method.

Show MeSH
Related in: MedlinePlus