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Video-assisted thoracoscopic surgery versus open thoracotomy in the management of empyema: A comparative study. | LitMetric

AI Article Synopsis

  • - The study investigates the effectiveness of video-assisted thoracoscopic surgery (VATS) compared to traditional open thoracotomy (OT) for treating thoracic empyema, highlighting the increasing use of VATS due to its minimally invasive nature.
  • - A comparison of clinical outcomes from 60 patients showed that VATS resulted in shorter surgery times, less chest tube drainage, reduced hospital stays, and lesser pain compared to OT, making it a more favorable option.
  • - The findings support using VATS as a preferred method when possible, while also recognizing that conversion to open surgery when necessary is a practical decision in surgical practice.

Article Abstract

Introduction: With a rise in the incidence of thoracic empyema, surgical interventions also have evolved from the traditional open decortication to the current minimally invasive video-assisted thoracoscopic surgery (VATS). In this study, we determine the feasibility of VATS and also put the superiority of VATS over open thoracotomy (OT) to test.

Subjects And Methods: Prospective single-centre comparative analysis of clinical outcome in 60 patients undergoing either VATS or OT for thoracic empyema was done between 1 September, 2014, and 1 November, 2018. Furthermore, another group of patients, who were converted intraoperatively from VATS to OT, was studied descriptively.

Results: Nearly 75% of the patients were male with a mean age of 45.16 years. Every second patient had associated tuberculosis (TB), attributed to the endemicity of TB in India. When compared with OT, VATS had a shorter duration of surgery (268.15 vs. 178.33 min), chest tube drainage (11.70 vs. 6.13 days), post-operative hospital stay (13.56 vs. 7.42 days) and time to return to work (26.96 vs. 12.57 days). Post-operative pain and analgesic requirement were also significantly reduced in the VATS group (P < 0.0001). Conversion rate observed was 14.2%, the most common reason being the presence of dense adhesions.

Conclusion: We conclude that VATS, a minimally invasive procedure with its substantial advantages over thoracotomy and better functional outcome, should be preferred whenever feasible to do so. Also if needed, conversion of VATS to the conventional open procedure, rather than a failure, is a wise surgical judgement.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486060PMC
http://dx.doi.org/10.4103/jmas.JMAS_249_19DOI Listing

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