Name of the Procedure:

Thoracostomy with open flap drainage for empyema

Summary

Thoracostomy with open flap drainage is a surgical procedure used to treat empyema, which is an infection that causes pus to accumulate in the pleural space (the area between the lungs and the chest wall). The procedure involves creating an opening in the chest wall to drain the pus and allow the infected area to heal.

Purpose

Thoracostomy with open flap drainage is performed to relieve symptoms caused by empyema, such as severe chest pain and difficulty breathing. The primary goal is to remove accumulated pus, prevent further infection, and promote lung re-expansion.

Indications

• Persistent or recurrent empyema despite antibiotic treatment
• Significant pleural effusion with signs of infection (fever, elevated white blood cell count)
• Respiratory distress due to compression of the lung by pus-filled pleural space
• Failed less invasive drainage attempts

Preparation

• Fasting for a specific period before the procedure (usually 6-8 hours)
• Adjustment or discontinuation of certain medications as advised by the physician
• Preoperative imaging studies like chest X-rays or CT scans
• Blood tests to check coagulation status and overall health

Procedure Description

1. The patient is positioned and prepped in a sterile manner.
2. General anesthesia is administered to ensure the patient is unconscious and pain-free.
3. A surgical incision is made in the chest wall to access the pleural space.
4. An opening (flap) is created to allow for continuous drainage of pus.
5. The pleural cavity is irrigated to remove infected material.
6. Drainage tubes are inserted to facilitate ongoing drainage.
7. The incision is partially closed, leaving room for drainage.
8. The patient is monitored in a recovery area.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity of the empyema and patient condition.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Operating room nurses
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Damage to nearby organs or tissues
• Respiratory issues
• Pain at the incision site
• Rarely, persistent air leaks or chronic drainage issues

Benefits

• Relief from symptoms such as chest pain and breathing difficulty
• Reduction in infection and promotion of lung re-expansion
• Improved overall respiratory function
• Reduced risk of future complications related to empyema

Recovery

• Post-procedure care includes pain management, antibiotics, and chest physiotherapy.
• The drainage tube remains in place until the infection resolves, which might take several days to weeks.
• Regular follow-up appointments to monitor healing and remove the drainage tube.
• Patients are typically advised to avoid strenuous activities until fully recovered.

Alternatives

• Needle aspiration or thoracentesis for less severe cases
• Video-Assisted Thoracoscopic Surgery (VATS) for a minimally invasive option
• Long-term antibiotic therapy might be considered in some cases
• Pros and cons depend on the severity of empyema, patient health status, and response to previous treatments

Patient Experience

Patients might experience initial discomfort and pain at the incision site, which is managed with pain medication. Breathing may become easier soon after the procedure due to relief from pressure. Regular monitoring and supportive care ensure comfort and a smooth recovery.