The Surgical Treatment of Chronic Empyema

One hundred fifty-four patients with chronic empyema have been reviewed. Various surgical procedures have been done to control the chronic empyema and complicating bronchopleural, pleurocutaneous or bronchopleural cutaneous fistulas. Drainage was relatively ineffectual in controlling the empyema, but was a valuable preliminary procedure in many patients to reduce the toxicity of the infection. When drainage failed and further surgery was not accomplished, the mortality rate was excessive. Thoracoplasty and resection were useful procedures in chronic complicated empyema, but with each procedure there was a significant number of failures. Decortication was most successful in this problem except when bronchopleural or bronchopleural cutaneous fistulas complicated the empyema. Thoracomediastinal plication was the most effective of the procedures reviewed for controlling the empyema even in the presence of bronchopleural, pleurocutaneous or bronchopleural cutaneous fistulas and has the advantage of being applicable following failure of the other corrective surgical procedures.