ICD Versus VATS as Primary Treatment in Fibrinopurulent Stage of Empyema Thoracis

Abstract

Background and objectives: Empyema thoracis is a condition in which pus collects in the pleural cavity. The optimal treatment of Empyema thoracis especially in the fibrinopurulent phase (Stage II) remains controversial. While the Inter Costal Drainage (ICD) is less invasive and cheap, it is not clearly proved that it is better than the Video Assisted Thoracoscopic Surgery (VATS) in terms of conversion into thoracotomy, morbidity and duration of hospital stay. No large randomized trial is available for comparing the two treatment strategies in the condition.

Methodology: This study was a prospective comparative study of ICD insertion versus VATS as primary intervention in the fibrinopurulent stage of Empyema thoracis, which was conducted over a period of 2 years (Dec 2008 to Nov 2010), in a tertiarry care Medical College Hospital. With an incidence of around 5-10% and a considerable burden in our hospital, the study was taken up to compare the efficacy of ICD versus VATS, in terms of morbidity and cost effectiveness and to identify the optimal way of managing the condition. The study included a total of 40 patients with each group consisting of 20 patients.

Sampling: Purposive sampling technique. The Statistical Methods Used: Descriptive statistics, Frequencies, Crosstabs, Independent sample t-test.

Results: It was found that VATS was better than the conventional ICD insertion in terms of the variables like mean duration of hospital stay (p<0.05), mean duration of the chest tube in situ (p<0.05), mean cost of the treatment (p<0.05), complications (p<0.05) and failure rate (p<0.05) which were statistically significant.

Conclusion: Our study concluded that Video Assisted Thoracoscopic Surgery is better than conventional ICD tube insertion as a primary mode of treatment in the fibrinopurulent stage of Empyema thoracis.

Keywords: Computed tomography thorax; Decortication; Thoracotomy; VATS.

[Table/Fig-1]:

Port positions in VATS; lower is the camera port

[Table/Fig-2]:

Bar diagram showing comparison of mean hospital stay (in days)

[Table/Fig-3]:

Bar diagram showing comparison of mean tube in situ duration (in days)

[Table/Fig-4]:

Bar diagram showing the comparison of failure (no. of patients)