Indications for VATS or open decortication in the surgical treatment of fibrino-purulent stage of parapneumonic pleural empyema

Open and Video-Assisted Thoracoscopycal pleural decortications are proved and effective surgical procedure in the surgical treatment of pleural empyema in the fibrinopurulent stage. Early referral to surgery gives a better chance of success in VATS pleural decortications than open decortications. Pleural morphology, biochemistry and biology can also affect the outcome of the surgical treatment of pleural empyema. The aim of this paper is to compare the results of VATS and open decortications of the pleura according to the preoperative morphological and biochemical conditions of the pleura and the pleural cavity as well as postoperative morphological and functional improvement in patients with parapneumonic, fibrinopurulent pleural empyema. Two different approaches (VATS and open pleural decortications) were analyzed in 37 patients divided into two groups. The biochemical analysis of pleural fluid (LDH, glucose, pH and albumins) and the pleural thickness of the chest CT scan were measured. The success of the operations was measured by plain chest X-ray and functional tests after 3 months postoperatively. The group with VATS pleural decortications showed a significantly (p