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The objective of this study is to demonstrate the effectiveness and feasibility in treating empyema after pulmonary resection with a modified Clagett procedure performed at the bedside (BMCP). A retrospective review of a single surgeon's experience at a single institution was undertaken. All operative, postoperative, and outcome data were analyzed. Follow-up data were obtained from subsequent clinic charts. Five patients, including four males, were identified who underwent BMCP after pulmonary resection. The original operative procedures included two lobectomies, one pneumonectomy, one bilobectomy, and one bilateral metastastectomy. Patients were diagnosed with an empyema (positive thoracostomy tube culture, fever, and radiographic abnormality) at a mean time of 31 days from their initial procedure. Culture results disclosed Gram-positive empyemas in all patients. Three patients underwent BMCP as an outpatient, whereas the other two had BMCP during their hospitalizations. All patients are free from complications or recurrence at a mean follow up of 11.2 months. No patient required a further procedure after BMCP. The bedside modified Clagett procedure is both safe and effective. It is a valuable option in the management of postoperative empyema because it avoids additional operative procedures. This procedure is cost-effective when compared with operative management of perioperative empyema.
EMPYEMA is A SERIOUS complication after pulmonary resection. Although the exact incidence of empyema after pulmonary resection is unknown, it is estimated that 5 per cent to 10 per cent of pneumonectomies and 1 per cent to 3 per cent of lobectomies are complicated by empyema.1,2 Half of the infections occur within the first 4 weeks after operation.
Traditional treatment of postresection empyema was developed by Clagett in 1963 when he described a two-stage procedure.3 The first stage entailed open thoracostomy drainage and closure of associated bronchopleural fistula (BPF) with a transposed muscle flap. Stage two followed with closure of the thoracostomy and instillation of antibiotic solution into the residual cavity. Failure of a traditional Clagett procedure is associated with a persistent BPF. Despite the need for multiple operative procedures, the traditional Clagett procedure has persisted in many centers because there are few alternatives in treatment.
Other authors have modified Clagett's initial procedure to include myoplasty and thoracoscopic instillation of antibiotic solution into the empyema cavity. Muscle transposition is recommended for instances in which there exists...