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Lung decortication for chronic empyaema: effects on pulmonary function and thoracic asymmetry in the late period

Sureyyapasa Chest Diseases and Thoracic Surgery Teaching Hospital, Maltepe 34758, Istanbul, Turkey

Received 13 October 2008; received in revised form 15 April 2009; accepted 27 April 2009.

^_* Corresponding author. Tel.: +90 2164214200; fax: +90 2164214265. (Email: erdalokur{at}hotmail.com).

Objective: Chronic empyaema deteriorates lung function and causes thoracic asymmetry due to intercostal narrowing in the diseased hemithorax. This study aims to investigate the rates of improvement in the pulmonary function tests (PFTs) and the thoracic deformity in late postoperative period of lung decortication, performed for chronic empyaema. Methods: A total of 50 patients who underwent standard open decortication for empyaema were included. The PFTs and computed tomographic (CT) scans of the chest were analysed in all patients after 6–58 months postoperatively. The measurements of antero-posterior and transverse diameters of both hemithoraxes were performed on both preoperative and postoperative chest CTs. The thoracic asymmetry was calculated as the ratio of the measurements of the diseased side to the normal side. The pre- and postoperative parameters were compared statistically. Results: The mean preoperative forced expiratory volume in first second (FEV₁) and forced vital capacity (FVC) increased from 61.40% and 60.89% to 78.92% and 77.48%, respectively, in the late postoperative period (p < 0.001). The mean preoperative transverse diameter of affected hemithorax increased from 11.22 cm to 11.98 cm (p < 0.001) and, the transverse asymmetry improved from 11.52% to 5.94%, postoperatively (p < 0.001). The mean preoperative antero-posterior chest diameter improved from 15.58 cm to 16.67 cm (p < 0.001), and the antero-posterior asymmetry improved from 11.42% to 5.42% (p < 0.001) in the late postoperative period. Conclusions: The open decortication for chronic pleural empyaema significantly increases FEV₁ and FVC. Due to the re-expansion of the lung and enlargement of the intercostal spaces, the chest wall deformity also improves considerably after the operation.

Key Words: Decortication • Empyaema • Fibrothorax • Pulmonary function tests • Thoracic asymmetry