Introduction: We present the technique and results of treating post pneumonectomy empyema (PPE) without bronchopleural fistula (BPF) with video-assisted thoracic surgery (VATS) debridement followed by continuous antibiotic irrigation for pneumonectomy space sterilization.

Methods: All patients underwent thoracic surgery (VATS) debridement followed by intraoperative placement of an 8 French irrigation and a 36 French drainage catheters. Two weeks of continuous antibiotic irrigation, as determined by cultures, was followed by collection of chest cultures on three consecutive days. If cultures returned negative, antibiotic was instilled into the chest and all catheters were removed. If cultures were positive, another two weeks of irrigation was reinitiated, adjusting the antimicrobial agent based on culture results. This regimen was repeated until three consecutive negative cultures were obtained.

Results: Over a 6 year period, five consecutive patients with PPE but without BPF were treated. During this period we performed 51 pneumonectomies for a PPE rate of 9.8%(5/51). No patients had BPF. Mean age was 66 years. Median time to empyema after pneumonectomy was 18 days (range 12 to 497). Mean irrigation duration was 37 days (range 18 to 72) and mean follow-up was 257 days (range 75 to 475). There was no treatment-associated morbidity or mortality. No patients experienced empyema recurrence during follow-up.

Conclusion: PPE without BPF can be successfully treated with minimally invasive techniques by VATS debridement followed by continuous antibiotic irrigation. This method avoids the morbidity of rib resection or thoracic cavity reduction procedures.