Abstract 

Background: Development of multiloculation and septation in complicated parapneumonic pleural effusion (PPE) may lead to difficult treatment. The studies pointed out that as fibrinolytic therapy might have the potential of complications and a time consuming character, so we should change our management strategy in such patients. 

Objectives: In this study, we aimed to investigate whether or not uniportal video-assisted thoracoscopic surgery (UVATS) is an initial effective therapy based on clinical and radiologic manifestations. 

Methods: In this retrospective study, sixty patients who underwent UVATS as the initial intervention with the diagnosis of multiloculated PPE were evaluated between 2016-2019. The patients comorbidities, ASA scores, durations of hospital stay and tube thoracostomy, rate of thoracotomy/decortication, the type of pleural fluid cell and also broad-spectrum antibiotic use, culture results, % neutrophil (NE) ratio with other biochemical parameters before and after VATS were recorded and analyzed. 

Results: Of the patients, 46 of them (77%) underwent UVATS and a subsequent second port incision was inserted in 14 patients,. Shortening of broad-spectrum antibiotic use after VATS was found to be statistically significant in the patients underwent early VATS (p <0.05). We found a statistically significant decrease in the rate of NE % after VATS (p <0.05), that is consistent with the clinical and radiological improvements. The radiological improvement was detected in 96.6% of the patients. 

Conclusion: We conclude that early UVATS without prior tube thoracostomy is a simple, effective and reliable method as the first-line treatment in patients with complicated PPE. It also confirms that earlier administration of UVATS and more aggressive therapy in the proper indications offers better clinical results. 

Keywords: Empyema, Multiloculation and Septation, VATS