Is Thoracoplasty Still a Choice in Management of Chronic Empyema with Non-Functioning Lung Associated with or Without Bronchopleural-Fistula

Dr. Anil Kumar Verma, Dr. Neeraj Kumar, Dr. Saikat Chaudhuri

Abstract: Introduction: Chronic empyema with a non-functioning lung, often accompanied by bronchopleural fistula (BPF), presents a complex clinical challenge in thoracic surgery. Traditionally, thoracoplasty has been used to address the persistent pleural space and promote lung collapse in these cases. However, with advancements in minimally invasive techniques and alternative surgical approaches, the role of thoracoplasty has been increasingly questioned. This paper aims to assess whether thoracoplasty remains a relevant and effective treatment option in the management of chronic empyema with non-functioning lung, with or without associated BPF. Methodology: A comprehensive literature review was conducted, focusing on studies published in the last two decades regarding the management of chronic empyema, non-functioning lung, and bronchopleural fistula. We analysed both historical and contemporary approaches, comparing outcomes of thoracoplasty with other interventions such as pleural decortication, thoracic drainage, and endoscopic procedures. A total of 50 studies, including case reports, retrospective reviews, and clinical trials, were included in the analysis. We also reviewed surgical technique variations, patient selection criteria, and post-operative outcomes. Conclusion: Thoracoplasty remain in the armamentarium of modern thoracic surgery. Due to the recrudescence of TB and other infectious diseases of the chest, it is possible that the number of patients requiring this kind of surgery will increase in the near future. We believe that sooner or later any thoracic surgeon will meet a patient requiring such a procedure. Thoracoplasty may solve complicated cases with good immediate and long-term outcome. In such situations, training, careful evaluation and an accurate surgical technique are essential to achieve good results.

Keywords: Chronic empyema, non-functioning lung, bronchopleural fistula, thoracoplasty, pleural disease, thoracic surgery, management, treatment options