XXXX : a role for open thoracotomy and decortication.

@entity1 @entity5 @entity3509 @entity328 @entity221 @entity456
BACKGROUND: Thoracentesis and antibiotics remain the cornerstones of treatment in stage I @entity3509 . The management of disease progression or late presentation is controversial. Open thoracotomy and decortication is perceived to be synonymous with protracted recovery and prolonged hospitalisation. Advocates of thoracoscopic adhesiolysis cite earlier chest drain removal and hospital discharge. This paper challenges traditional prejudice towards open surgery. METHODS: A five year audit of @entity3509 cases referred to a regional cardiothoracic surgical unit analysing previous clinical course, surgical management, and outcome. RESULTS: Between February 1992 and February 1997, the number of referrals to this centre increased dramatically. Twenty-two @entity1 were referred for surgery (15 @entity1 , seven @entity1 ; age range, 0.5-16 years). Before referral, @entity1 had been unwell for 6-50 days (median, 15), had been treated with several antibiotics, and had undergone chest ultrasound (15 @entity1 ), computed tomography (five @entity1 ), @entity456 (13 @entity1 ), and intercostal drainage (seven @entity1 ). The organism responsible was identified in only two cases ( @entity328 ). Three @entity1 had intraparenchymal abscess formation. Eighteen @entity1 underwent open thoracotomy and decortication. Drain removal was performed on the first or second day. @entity221 resolved within 48 hours. Median hospital stay was four days. All @entity1 had complete clinical and radiological resolution. CONCLUSIONS: Treatment must be tailored to the disease stage. In @entity5 , open decortication followed by early drain removal results in rapid symptomatic recovery, early hospital discharge, and complete resolution. In the early fibrinopurulent phase, alternative strategies should be considered. However, even in ideal cases, neither fibrinolysis nor thoracoscopic adhesiolysis can achieve more rapid resolution at lower risk.
