Özgür Ömer YILDIZ, Göktan TEMİZ, Nurettin KARAOĞLANOĞLU, Ömer Cenap GÜLYÜZ, İlknur Aytekin ÇELİK

The comparison of vacuum assisted closure (VAC) and conventional treatment methods in postpneumonectomy empyema cases

Aim: Postpneumonectomy empyema is one of the most difficult clinical conditions in thoracic surgery. There is a wide range ofconventional treatment options ranging from tube thoracostomy, antibiotic irrigation to open-window thoracostomy. VacuumAssisted Closure (VAC) therapy is also among the treatment options. In our study we aimed to compare the outcomes and efficiencyof conventional treatment procedures and VAC.Material and Methods: Eighteen male patients (average age 54.8± 18.68), who were diagnosed with postpneumonectomy empyemabetween July 2012 and November 2014, were divided into two groups. Nine patients (Group I) have been treated with conventionalprocedures, while the other nine patients (Group II) have been treated with VAC.Results: Five patients in the Group I were cured in an average of 9.6 months. Four patients underwent additional surgical interventionand they remained in the empyema clinic for 12 months in the follow-up period. Seven patients in the Group II were cured duringthe follow up period of an average of 14.8 months. Two patients who developed bronchopleural fistula remained in the empyemaclinic. Average length of hospital stay is 109.3 days for the Group I and 63 days for the Group II. The treatment of the Group II hasbeen found more successful than the Group I in terms of pain status assessment, patient’s comfort and postoperative cosmeticappearance.Conclusions: VAC group success rate has been found higher in terms patient’s comfort, the length of hospital stay and duration ofempyema. Further studies are required to establish the success of this procedure.

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1. Zaheer S, Allen MS, Cassivi SD, et al. Postneumonecetomy empyema: results after the Clagett procedure. Ann Thorac Surg 2006;82:279-86.
2. Ditterich D, Rexer M, Rupprecht H.Vacuum assisted closure in the treatment of pleural empyema first expriences with intrathoracal application. Zentralbl Chir 2006;131133-8.
3. Kim EA, Lee KS, Shim YM, et al. Radiographic and CT Findings in Complications Following Pulmonary Resection. Radiographics 2002;22:67-86.
4. Garcia-Yuste M, Ramos G, Duque JL, et al. Open-window thoracostomy and thoracomyoplasty to manage chronic pleural empyema. Ann Thorac Surg 1998;65:818-22.
5. Matzi V, Lindenmann J, Porubsky C, et al. Intrathoracic insertion of the VAC device in a case of pleural empyema after pneumonectomy. Ann Thorac Surg 2007;84:1762-4.
6. Palmen M ,van Breugel HN, Geskes GG, et al. Open window thoracostomy treatment of empyema is accelerated by vacuum-assisted closure. Ann Thorac Surg.2009;88:1131-6.
7. Aru GM, Jew NB, Tribble CG, et al. Intrathoracic vacuumassisted managment of persistent and infected pleural spaces. Ann Thorac Surg 2010;90:266-70
8. Al-Mufarrej F, Margolis M, Tempesta B, Strother E, Gharagozloo F. Outpatient managment of post-pneumonectomy and postlobectomy empyema using the vacuum-assisted closure system. Surg Today 2010;40:711-8.
9. Saadi A, Perentes JY, Gonzalez M, et al. Vacuum-assisted closure device; a useful tool in the management of severe intrathoracic infections. Ann Thorac Surg 2011;91:1582-9.