RESUMO
INTRODUCTION: Pleural empyema in a post-pneumonectomy cavity (PEC) occurs with a frequency of 2%â-15% and a mortality of more than 10%. It can occur with or without bronchopleural fistula (BPF). The treatment of empyema in the PEC requires a strict algorithm: drainage, bronchoscopy, closure of the fistula, thorough cleaning of the PEC, filling the cavity, thoracoplasty. METHODS: 39 cases with an empyema in the PEC were analysed retrospectively (men: nâ=â38; women: nâ=â1; mean age: 60.3â±â7.6 years). In 32 (82.1%) of the patients, a BPF was detected (right: nâ=â26, left: nâ=â6). The average length of stay in hospital was 125 days (22â-â293 days). Cleaning of the PEC was achieved in all surviving patients (nâ=â23, 65.1%). All patients (nâ=â39) underwent bronchoscopy with placement of a chest tube for drainage. The BPF was closed in three cases (7.7%) with a stent while in 12 cases (30.8%) a vascularized flap was used. In 14 patients (35.9%) the bronchial stump was either reclosed with sutures or resected. In three cases (7.7%) a re-anastomosis was performed. RESULTS: The PEC became sterile by regular flushing with antibiotic solution in three patients (7.7%). In 35.9% of the patients (nâ=â14), aggressive surgical debridement (Weder procedure) was necessary. A thoracic window was applied in 22 patients (56.4%), followed by negative pressure wound therapy (NPWT) and change of dressing every three to four days or a tamponade of the thoracic cavity with simple dressings. In 19 patients (48.7%) the thoracic cavity was sealed with an antibiotic solution. In 5 cases an Alexander thoracoplasty took place. CONCLUSIONS: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A bronchopleural fistula is often detected. Thus, two problems arise at the same time fistula and infection in the pleural cavity. Through a strict algorithm, both problems can be dealt with in stages. After sealing the fistula, the thoracic cavity is thoroughly cleaned and finally the thorax is closed. Only in a small number of patients (1.3%) in whom these measures remain ineffective (persistent MRSA, aspergillus colonization) should the cavity be obliterated by thoracoplasty.