Extrapleural enucleation of empyema (empyemectomy)
CPT4 code
Name of the Procedure:
Extrapleural Enucleation of Empyema (Empyemectomy)
Summary
Extrapleural enucleation of empyema, commonly known as empyemectomy, is a surgical procedure to remove infected pus-filled pockets (empyema) from the space between the lungs and the chest wall. The goal is to eliminate the infection and improve lung function.
Purpose
Empyemectomy addresses empyema, a condition where pus accumulates in the pleural cavity, often due to infections like pneumonia or complications from surgery. The procedure aims to remove the infected material, alleviate symptoms, and restore normal lung function.
Indications
- Persistent fever despite antibiotic treatment
- Shortness of breath
- Chest pain
- Thickened pleural membrane seen on imaging
- Failure of less invasive treatments such as thoracentesis or chest tube drainage
- Empyema diagnosed through imaging and laboratory tests
Preparation
- Fasting for at least 8 hours prior to the procedure
- Stopping certain medications as advised by the doctor
- Preoperative imaging studies like chest X-ray or CT scan
- Blood tests to check overall health and coagulation status
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A surgical incision is made on the chest wall to access the pleural cavity.
- Extrapleural Dissection: The surgeon carefully separates the pleural membrane from the underlying lung and chest wall tissues.
- Enucleation: The infected pleural membrane and pus pockets are removed.
- Irrigation: The pleural cavity is thoroughly cleaned with a saline solution.
- Closure: The surgical site is closed using sutures or staples, and a chest tube is often placed to drain any remaining fluid and air.
Tools and equipment used include surgical scalpels, forceps, retractors, suction devices, and irrigation systems.
Duration
The procedure typically takes between 1 to 3 hours, depending on the extent of the empyema and the complexity of the case.
Setting
Empyemectomy is performed in a hospital operating room.
Personnel
- Thoracic Surgeon
- Anesthesiologist
- Surgical Nurses
- Operating Room Technicians
Risks and Complications
- Infection
- Bleeding
- Air leakage from the lung (pneumothorax)
- Pain at the incision site
- Rarely, injury to nearby organs such as the lung or heart
- Prolonged air leak or respiratory complications
Benefits
- Removal of infection and pus from the pleural cavity
- Relief from symptoms such as chest pain and breathing difficulties
- Improvement in lung function
- Prevention of further complications associated with untreated empyema
Benefits are generally realized within a few weeks as the patient recovers and the infection clears.
Recovery
- Hospital stay for a few days post-surgery
- Pain management with prescribed medications
- Instructions to avoid heavy lifting and strenuous activities for a few weeks
- Follow-up appointments to monitor recovery
- Chest tube care if still in place
- Breathing exercises to improve lung function
Expected recovery time ranges from 4 to 6 weeks, depending on the patient's overall health and response to surgery.
Alternatives
- Antibiotic therapy and observation
- Image-guided percutaneous drainage
- Video-assisted thoracoscopic surgery (VATS)
- Open thoracotomy and decortication
The choice of alternative treatment depends on the severity of the empyema and the patient's overall health. Non-surgical options are less invasive but might not be as effective for severe cases.
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel pain or be aware of the surgery. Postoperatively, patients may experience some discomfort and pain at the incision site, managed through pain relief medications. Breathing exercises and physical therapy may be recommended to facilitate recovery and improve lung function.