Volume 14, Supplement 1
Original Article / Published: April 2026
DOI: https://www.doi.org/10.57045/jemis/1410426.pp25-26
N. Tsonevski, S. Amiri, V. Yordanov, T. Badarov, A. Dimitrova
Clinic of Thoracic Surgery – MMA “MPHAT – Sofia”
Abstract
Introduction: Pleural empyema is a complex clinical condition characterized by the accumulation of pus in the pleural cavity, usually due to pneumonia, malignancy, or postoperative complications. One of its complications is broncho-pleural fistula, which is a communication between the bronchial tree and the pleural cavity.
Objective: To establish the place of videothoracoscopy in the treatment of pleural empyema with broncho-pleural fistula.
Matherials and methods: For the period January, 2021 – April, 2025, 21 patients with histologically verified pleural empyema and clinically and/or diagnostic imaging established broncho-pleural fistula were treated at the Thoracic Surgery Clinic, Military Medical Academy– Sofia. The clinical and imaging data, the therapeutic approach and the hospital stay were analyzed.
Results: The average age of the patients presented was 63.6 years, 19 of whom were men and 2 were women. The main complaints were pain in the corresponding chest half and purulent expectoration. Imaging diagnostics revealed pleural effusion in all, more often encapsulated and with hydro-aeric levels. In 100% of cases, the treatment of choice was videothoracoscopy with evacuation of the inflammatory effusion, debridement and removal of all septa and adhesions to achieve full expansion of the lung. A second stage suture of the fistula was performed in 5 of the patients after intravenous antibiotic treatment. Another 5 were discharged with oral antibiotic therapy and a thoracic drain, which was removed on average after 1.5 months. One patient had a recurrence of pleural empyema 5 weeks after discharge and underwent a second videothoracoscopic treatment. Four of the patients remained with permanent thoracostomy. One fatal outcome was recorded. In the remaining cases, the postoperative period was uneventful with an average hospital stay of 10.5 days.
Conclusion: Videothoracoscopy is the method of choice, which is safe and effective in the treatment of pleural empyema with fistula
Keywords:
pleural empyema, bronchopleural, fistula, videothoracoscopy
How to cite this article:
N. Tsonevski, S. Amiri, V. Yordanov, T. Badarov, A. Dimitrova. A minimally invasive approach to the treatment of pleural empyema with broncho-pleural fistula. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2026; 14(1): 25-26
Corresponding author:
D-r Nenad Tsonevski
Email: nenadconevski@icloud.com
Mobile: +359 89 767 9709