A dedicated prosthesis for open thoracostomy

Our plain-English summary of A dedicated prosthesis for open thoracostomy, by L.T. Filomeno, J.M. de Campos, A.W. de Almeida, et al (The Annals of Thoracic Surgery, 1997).

The study

• Authors: L.T. Filomeno, J.M. de Campos, A.W. de Almeida, C. Werebe Ede, F.B. Jatene, A.A. Leirner
• Journal: The Annals of Thoracic Surgery
• Published: 1997;63(5):1494-6
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Due to our dissatisfaction with the mutilation caused by the skin-lined open thoracostomy, we have developed a dedicated prosthesis that is expected to avoid or to substitute for the classic operation. The prosthesis is a corrugated silicone tube with an oval flange at one end (to fix it internally) and a mobile ring on the other (to fix it externally). It is inserted at the bottom of the empyematic cavity after 3 cm of a rib is removed. We have used it in 20 patients whose empyema was secondary to pneumonia (12) or complications of pneumonectomy (4), lobectomy (2), decortication (1), or pleuroscopy (1). Six of those patients have already been cured and their prosthesis removed after 54 to 305 days. In 1 with a persistent postpneumonectomy bronchopleural fistula the device was removed after 299 days and the patient was submitted to a limited thoracoplasty. Six other patients still have unresolved cavities and have been using the prosthesis for 63 to 302 days. Seven patients died of their underlying disease (bilateral pneumonia, 2; acquired immunodeficiency syndrome, 2; mesothelioma, 1; heart failure and pulmonary embolism, 1; unknown, 1) after using the prosthesis for 11 to 160 days. In those patients from whom the prosthesis already has been removed, the scar looks like those commonly seen after removal of an ordinary chest tube. Based on these early favorable results we feel most encouraged to persist in this research. Nevertheless, we are aware that a larger number of patients and a longer follow-up will be necessary before we may make definitive recommendations.

In plain English

This article from the University of São Paulo, Brazil, described a new surgical device and its early use. It is not a study of asbestos exposure. The authors designed a corrugated silicone tube, inserted after removing 3 cm of one rib, as an alternative to the large skin-lined open thoracostomy (a wide opening in the chest wall) used to drain chronic empyema, a long-lasting infection in the space around the lung. Between April 1995 and September 1996, 20 patients were treated. Six were cured and had the tube removed after 54 to 305 days. Six more were cured of the infection but still had leftover cavities, so they kept the tube. One patient with a bronchopleural fistula had the tube removed after 299 days and was then treated with a limited thoracoplasty. One patient developed a complication and died of bilateral pneumonia and septic shock on the 15th day after surgery. Six patients died of their primary diseases while using the tube, and one of these had diffuse mesothelioma. The authors were encouraged to continue but said more patients and longer follow-up were needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Description of a new surgical technique and device, with an uncontrolled series of 20 treated patients
• Who was studied: 20 patients with chronic empyema (parapneumonic 12, postpneumonectomy 4, postlobectomy 2, postdecortication 1, postthoracoscopy 1), treated April 1995 to September 1996 at the University of São Paulo, Brazil
• Exposure: No asbestos exposure was studied. The treatment examined was a corrugated silicone tube prosthesis (10 x 2.5 cm, 2.0 cm internal diameter) inserted after resecting 3 cm of a rib.
• Main results:
  • 6 patients (postpneumonectomy 1, parapneumonic 5) were cured of empyema and had the prosthesis removed after 184, 54, 56, 67, 115, and 305 days
  • 6 other patients were cured of pleural suppuration after 48, 63, 200, 279, 304, and 312 days but still had residual cavities and kept the prosthesis
  • 1 patient with postpneumonectomy empyema and an 8-mm bronchopleural fistula had the prosthesis removed after 299 days and was managed by a limited thoracoplasty
  • 2 patients had postoperative complications. One died of bilateral pneumonia and septic shock on the 15th postoperative day. The other had bleeding that was controlled at reexploration the next morning.
  • 6 patients died of their primary diseases while still using the prosthesis (bilateral pneumonia 1, diffuse mesothelioma 1, AIDS 2, heart failure and pulmonary embolism 1, unknown 1). The prosthesis had been in place 11 to 156 days.
• The authors' conclusion: The authors said the early favorable results encouraged them to keep using the prosthesis instead of conventional open thoracostomy for chronic empyema.
• Limitations the authors state:
  • The authors stated that more observation time and more treated cases are needed before final conclusions can be drawn

Topics

Medical terms in this study, explained in our Lexicon: Empyema, Pneumonectomy, Bilateral, Mesothelioma.

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