الفهرس 
Anatomy and physiology of the pleuraOnly 14 pages are availabe for public view
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Abstract
Background: Few thoracic conditions present such a considerable challenge as does pleural empyema. The disease is known since Hip- pocrates’ time, nonetheless it is still associated with the rising incidence all over the world. Minimally invasive procedures be- come more and more popular in many fields of surgery as well as in patients with pleural empyema. However, video-assisted thoracoscopy cannot replace open surgery in all empyema cases.
Objectives: to determine the outcomes of patients with early empyema stage I and II who underwent VATS washout with or without decortication on short and mid term basis.
Methods: October 2013 till March 2016, 60 patients who underwent VATS washout of early empyema stages I and II. This study was conducted in Ain shams university hospitals and affiliated hospitals.
Results: mean age 40.7 ± 1.8 years, 46 (76.7%) were males and 14(23.3%) were females The cause of empyema was post pneumonic in 31(51.7%) cases and post traumatic infected haemothorax in 29(49.3%) cases, 19 (31.7%) of cases were stage I exudative phase and 41(68.3%) were stage II fibrino-purulent empyema, there was no risk factors in 35 cases, 21 cases were diabetics, 1 case was chronic renal failure patient on regular dialysis and 3 cases were on cytotoxic drugs. Wash out only done in 20 cases (33.3%), Wash out and Decortication in 40(66.7%) cases. Only 17 patients needed ICU admition with mean duration of ICU Stay postoperative was 0.3 ± 0.06 (SEM) days. The mean duration of Hospital Stay was 4.2 ± 0.2 (SEM) days. There was no mortality and no patient suffered from any major morbidity. There was only 3 cases (5%) who needed another open decortications through thoracotomy at 8 and 12 weeks after the VATS procedure, the three patients had been referred late after four weeks from onset of symptoms but were given a trial of thoracoscopic drainage.
Conclusions: Thoracoscopic management of early stages of empyema should be the golden standard of management in surgically fit patients; particularly in the fibro-exudative phase of empyema. It is an effective and safe technique that reduces hospital stay and avoids the need for a decortication via a thoracotomy in most cases.