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

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.