Advancements in Pleural Empyema Management: Navigating Current Trends and Innovations through Anatomy-Guided Approaches

Abstract

Background: Pleural empyema, marked by pus accumulation around the lungs, presents a formidable clinical challenge. Current trends emphasize anatomy-guided approaches, leveraging advanced imaging and minimally invasive techniques. This shift recognizes the significance of precise anatomical localization for tailored interventions, promising improved outcomes. The evolving landscape underscores the potential of innovative strategies to enhance the management of pleural empyema. Objective: This study aimed to find out the anatomy-guided approaches for pleural empyema and Outcomes of Surgical versus non-surgical treatment of pleural empyema Methodology: The current retrospective cohort research was conducted at LRH on hospitalized patients with empyema who received treatment on a regular schedule between January 2021 and 2023. The present retrospective cohort analysis was conducted in a single location using anatomy-guided approaches by surgery (VATS & open thoracotomy decortication techniques) and non-surgical (medical & chest tubes drainage with or without fibrin lytic drugs) treatments related to thoracic surgery/General surgery and respiratory medicine wards. The statistical test instrument used was the independent t-test on demographic data.  Results: out of 130 patients, the cure rate was 27 % (n=35), while the death rate was 0.3% (n=1). A VATS decortication was performed on 13 out of 149 individuals who were judged to be in Stage II. The technique was turned into an open procedure when the findings revealed a 0% success rate—decortication after thoracotomy.  Patients who had thoracotomy decortication got a cure rate of 96.4%, and there were two deaths out of the 113 patients. N=2 (1.8%) required an open window thoracostomy due to an untreated empyema, whereas four (3.5%) required thoracoplasty. The patients treated with tube thoracostomy and chest incision decortication had total hospitalization durations of 15.4 ± 2.1 and 6.2 ± 1.8 days (P < 0.001). Accordingly, 98.2% and 27.1% were the success rates for surgical and non-surgical therapies. Furthermore, there was a substantial difference (P < 0.001) between them. Conclusion: Thoracotomy decortication treatment is generally the first rank choice with more excellent success rates than non-surgical approaches because of the advanced stages of empyema in our patients. However, these days, most research reports on the efficaciousness of non-surgical and VATS care of empyema.