Omentoplasty together with thoracoplasty in the treatment of postpneumonectomy pleural empyema

Objectives: During 2 years 5 patients were treated with postpneumonectomy pleural empyema. Three patients had clinical signs of bronchial stump fistula confirmed by bronchoscopy and during thoracotomy. Three patients had right and 2 left sided pleural empyema. Preoperatively 4 patients were treated with tube thoracostomy and pleural irrigation (median 21 days). In one case no preoperative drainage procedure was used. Methods: All patients were treated by partial thoracoplasty and omental transfer as single-stage operation. Thoracoplasty was performed extra-pleurally according to CT findings to reduce the volume of the empyema cavity. Subsequently empyema cavity was opened and cleaned. Upper midline incision was used to mobilize omentum majus and transfer it through the diaphragm into thoracic cavity. Results. In 3 patients omentum filled the cavity only partially but that did not influence results of the treatment. All patients recovered without major complications, 2 patients had nausea during first postoperative days. No recurrence of pleural empyema occured. Conclusion: Omentoplasty together with partial thoracoplasty is safe and effective method in the treatment of postpneumonectomy pleural empyema both with or without broncial stump fistula.