Comparative Study Between Early Outcomes of Open and Video Assisted Thoracoscopic Decortications

Background: Lung decortication is a well-known procedure that was first performed by Delorme for the treatment of empyema in 1895. Aim: To compare between open and video assisted thoracoscopic(VATS) decortications in cases of tough fibrosed pleura trapping lung or changing chest wall configuration.Patients and methods: This prospective comparative clinical study was conducted on 40 patients divided into two groups: Group A: (control group) 20 patients managed with conventional thoracotomy after 6 to 8 weeks of active drainage and Group B: 20 patients managed thoracoscopically at Suez Canal University Hospitals, Cardiothoracic Surgery Department from September,2023 to April,2024. Results:In group (Ⅰ) 2 cases needed postoperative ventilation for maximum 24 hours and 3 cases in group (Ⅱ) needed postoperative ventilation for maximum 120 hours with no significant difference between them. 50% of cases required postoperative ICU admission for monitoring and analgesia the range ICU stay was 24.0 – 240.0 hours in thoracotomy patients and 24.0 – 192.0 hours in VATS patients and there was no significant difference between both groups. According to postoperative chest infection, 12.5% of cases developed postoperative chest infection, 4 cases in the thoracotomy group and 1 case in the VATS group with no statistically significance difference.Conclusion: While both techniques appear safe and effective, VATS holds considerable promise for managing pleural effusions due to its faster surgery time, reduced blood loss, and most importantly, quicker post-operative recovery, leading to shorter hospital stays and potentially faster returns to normal life.