USE OF MODIFIED ELOESSER FLAP IN THE MANAGEMENT OF COMPLICATED EMPYEMA THORACIS A STUDY OF 129 CONSECUTIVE CASES

Abstract

Back ground - Empyema is the collection
of pus within the pleural cavity. Complicated
effusions or empyema which do
not respond to medical management or
intercostal drainage, require surgical intervention.
Decortication, Eloesser flap
procedure and thoracoplasty are the
commonly employed surgical techniques.
When the underlying lungs are too diseased
to be satisfactorily docorticated
and when the patient is very sick, toxic or
has other major co morbid conditions,
the Eloesser flap is an invaluable option
in the management. This technique was
first described by Leo Eloesser in the
year 1935 for tuberculous empyema in
the pre antibiotic era. (1) Various modification
of this technique, also called the
window procedure is employed now a
days when indicated. We endeavored to
study the use of this technique in the
management of complicated empyema in
a tertiary care centre.
Methodology - From the database, the details
of all the patients who underwent surgery
for treatment of empyema were retrieved
and studied.Results - Two hundred
and fifty two cases of empyema required
surgery over the last 5 years. Of these, 129
patients were subjected to a window procedure.
Most patients were referred after due
medical management by the pulmonologists
and twenty patients presented as
complications of previous surgeries. 31 patients
were smokers and 19 were diabetic.
9 had bronchopleural fistulae. 6 of the cultures
and 20 of the biopsies were confirmatory
of tuberculosis. The mean hospital
stay postoperatively was 6.4 days and the
average follow up was for 11 months. Most
windows healed by 6 months. Diabetes,
debility, malnutrition, drug resistant tuberculosis,
immunosupression and the presence
of bronchopleural fistulae delayed the
healing of the window. Four patients required
their window to be refashioned in
the process of healing and two patients

opted to have elective window closure. Conclusion
- The modified window procedure is an
invaluable option in the management of empyema
thoracis when indicated. Patient compliance
is good and the recovery time acceptable.