Thoracic and Chest Disease
Stephen M. Cohn, Peter Rhee in 50 Landmark Papers, 2019
Empyema management has also moved to the less invasive route. Empyema exists in three stages, where each stage gets progressively more scars and is more difficult to evacuate. Without appropriate debridement of the infectious material and release of the lung, respiratory status will fail and sepsis will progress. Open thoracotomy with decortication has been the mainstay, but minimally invasive procedures have since been taken seriously in the last 15 years. Video-assisted thoracoscopic surgery (VATS) has gained popularity in its use for the decortication of stage 2 and 3 empyema. Tong et al. (2010) looked retrospectively over a 10-year period at their institution on VATS versus open decortication for benign disease. To date, they have one of the largest numbers of patients included in a study. Three hundred twenty-six VATS and 94 open decortication patients were identified, with an 11.4% conversion to open rate on the VATS patients. The VATS group was found to have shorter operative time, hospital length of stay (LOS), fewer complications, and lower mortality.
The Surgical Management of Tuberculosis and Its Complications
Peter D O Davies, Stephen B Gordon, Geraint Davies in Clinical Tuberculosis, 2014
Definitive surgical treatment will speed re-expansion and resolution of the chronic infection but is dependent upon the fitness of the patient and the state of the lung as assessed by CT scanning. Decortication can be difficult if the visceral cortex is calcified, as may be the case in empyemata that occur many years after the tuberculous infection, and this situation is akin to the problems associated with collapse therapy. If the cortex can be removed, the lung will re-expand if the parenchyma is healthy. If bronchiectasis is present in a segment, lobe or the whole lung, pulmonary resection should be combined with decortication. If the residual lung is too small to fill the hemithorax, due to extensive resection or parenchymal fibrosis, one of the space-filling techniques described earlier will be added to decortication, unless pneumonectomy has proven necessary. Given the bilateral nature of the lung damage that is often present, the surgeon will strive to preserve any functioning lung tissue on the side of the empyema.
Acquired Bleeding Disorders Associated with the Character of the Surgery
Harold R. Schumacher, William A. Rock, Sanford A. Stass in Handbook of Hematologic Pathology, 2019
Vertebral fusion for scoliosis. Mechanism: This is usually a lengthy operative procedure ranging from 3 to 4 1/2 hr, with large areas of decortication of bone. The long exposure of blood to tissue thromboplastin at the wound site results in a consumptive coagulopathy or DIC. This results in the progressive loss of platelets and clotting proteins (150,151,158,159). Management: After visual assessment of blood loss, and vital signs, intraoperative coagulation studies can quantify the loss of platelets and clotting proteins. Specific correction should be made intraoperatively with fresh frozen plasma, cryoprecipitate, and/or platelet concentrates as defined by the intraoperative laboratory assessment. Delay of the coagulation assessment can result in significant dilutional coagulopathy unknown to the surgeon.
Lemierre’s syndrome treated operatively
Published in Baylor University Medical Center Proceedings, 2020
Allison T. Lanfear, Mohanad Hamandi, Joy Fan, Madison L. Bolin, Michael Williams, J. Michael DiMaio, John Waters
Pleural space disease may require additional interventions, such as tissue plasminogen activator, video-assisted thoracic surgery, and thoracotomy. The use of intrapleural tissue plasminogen activator to break down septations and minimally invasive surgery has been effective in cases of LS with bilateral parapneumonic effusions, cavitary pulmonary disease, and pleural effusions.6,10 When delayed diagnosis results in overwhelming sepsis, severe respiratory failure, and the presence of empyema, thoracotomy with decortication has been employed.11,13 In our patient, a severe right-sided pleural effusion resisted antibiotic treatment and intrathoracic lytic therapy. Thus, surgical decortication was performed, which proved effective.
Awake thoracic epidural anesthesia for uniportal video-assisted thoracoscopic pleural decortication: A prospective randomized trial
Published in Egyptian Journal of Anaesthesia, 2022
Mohamed Rabeea, Esam Abdalla, Hussein Elkhayat, Fatma Nabil
Lung decortication is the surgical procedure performed in cases of chronic stage IІ/IІI empyema to evacuate the purulent organized collection and to remove the restrictive fibrous membrane overlying the lung parenchyma to allow complete lung expansion [16]. For long time, decortication was done via open thoracotomy owing to the fact that at stage III empyema, ribs will be crowded, small working space and retracted chest wall would render the procedure difficult to be performed through minimal invasive approach. Recently, several publications investigated the possibility of uniportal VATS decortication with good results but very few of those publication investigate the feasibility of awake uniportal VATS decortication [3,4].
Retrospective review of intrapleural therapy for pleural infections: “Real life” outcomes and challenges
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2018
Catherine Robitaille, Céline Dupont, David Valenti, Jonathan Spicer, Christian Sirois, Anne V. Gonzalez, Stephane Beaudoin
Pleural infections are responsible for significant morbidity, mortality and healthcare costs.1 The mainstay of treatment consists of broad-spectrum antibiotics, chest tube drainage2,3 and, since the MIST-2 randomized controlled trial, the addition of intrapleural fibrinolytics and mucolytics.4 Surgical decortication by thoracoscopy or thoracotomy, may be required in patients in the fibrinopurulent or organizing phases or for patients refractory to intrapleural therapy.5
Related Knowledge Centers
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