O-142
COMPARISON OF VIDEO-ASSISTED THORACOSCOPIC SURGERY AND OPEN THORACOTOMY FOR DECORTICATION OF CHRONIC EMPYEMAS: A RANDOMIZED CONTROL TRIAL

Objectives: Decortication by posterolateral thoracotomy has been the gold standard in the management of chronic empyemas. Thoracoscopic surgery has been proven to be equally effective as thoracotomy in the management of stage II and early stage III empyema by various studies, but its role in patients with chronic empyemas presenting with gross pleural thickening and rib crowding is not well defined. We present a prospective randomized control trial done to evaluate the efficacy of thoracoscopic decortication in comparison with open decortication in patients having empyema of six months or more.

Methods: Thirty patients with chronic empyema history of six months or more were included from July to September 2015. There were 21 males and 9 females with a mean age of 26 years and a mean duration of symptoms of 15 months. Thirteen patients underwent thorascopic decortication and 17 underwent thoracotomy. Single-chest tube was inserted and a digital suction drain was used in all patients postoperatively. Intraoperative and postoperative analgesia for both groups was similar. Various parameters in two groups were analysed.

Results: Mean operative time for thoracoscopy was 175 min and for thoracotomy it was 111 min (P > 0.001). Mean postoperative pain score in thoracoscopy and thoracotomy was 5.85 and 6.12 respectively (P = 0.63). The mean duration of chest tube removal for thoracoscopy and thoracotomy was 4.6 and 4.5 days respectively (P = 0.73). Three cases of thoracotomy had superficial wound infection while none in case of thoracoscopy (P = 0.09). Mean hospital stay for thoracoscopic and thoracotomy groups was 9.92 and 10.05 days respectively (P = 0.70). There was no recurrence after one month follow-up in either group.

Conclusion: The benefit of thoracoscopic decortication over open decortication seems to be less in chronic empyemas when the duration of symptoms is more than 6 months. A larger study may be necessary for conclusive evidence.

Disclosure: No significant relationships.