Treatment of pleural empyema (abscess) with pleurectomy and lung decortication in University Hospital of Ludwig Maximilian University of Munich

About the department

The Department of Thoracic Surgery at the University Hospital of Ludwig Maximilian University of Munich offers modern and the most sparing surgical treatment of the full range of diseases of the chest organs. Particular attention is paid to the treatment of malignant tumors of the lungs, pleura, and mediastinum, and lung metastases. The medical facility is certified as a Lung Cancer Center by the German Cancer Society (DKG). Such a quality certificate testifies to the outstanding quality of lung cancer treatment, which belongs to a group of particularly complex malignant diseases. The team of surgeons also has excellent professional skills in treating emphysema, pneumothorax, pleural empyema, and pleurisy. The department performs all surgical interventions in the field of reconstructive thoracic surgery, including the repair of pectus carinatum and pectus excavatum. The department is a Center of Excellence for Lung Transplant (Munich Lung Transplant Group, MLTG) and performs the largest number of lung transplants in all of Germany. The department's surgeons have a perfect command of minimally invasive and endoscopic techniques, so the number of classic open surgeries is negligible. The department is headed by Prof. Dr. med. Rudolf Hatz.

Lung cancer is one of the three most common oncological diseases, and its treatment is a complex task. In most cases, lung cancer is diagnosed in its advanced stages, since before that a person does not have any symptoms and is unaware of the presence of the pathology. The treatment of this type of oncology requires a comprehensive and professional approach, which patients are guaranteed to receive at a specialized Lung Cancer Center on the basis of the department. Patients with suspected lung cancer undergo many diagnostic examinations, the results of which help doctors to determine the most effective treatment tactics. A diagnostic protocol includes pulmonary function tests, endoscopic tests, computed tomography of the chest and abdominal cavity, positron emission tomography, and a biopsy followed by a histological examination.

Depending on the tumor size and the stage of cancer, thoracic surgeons perform tumor resection or removal of the lung lobe and adjacent lymph nodes affected by the oncological process. Patients with small tumors undergo minimally invasive surgery with video-assisted thoracoscopic surgery (VATS). For large tumors or neoplasm invasion in the thoracic wall, open surgery is still the best option. The team of thoracic surgeons at the medical facility performs hundreds of lung cancer surgeries every year, so the doctors have tremendous experience and achieve impressive therapeutic results. The treatment regimen for each patient is developed in collaboration with pulmonologists, oncologists, radiation therapists, and specialists in the field of nuclear medicine, since curing lung cancer requires an interdisciplinary approach and the use of various therapeutic methods. Surgery is often supplemented with chemotherapy, radiation therapy, chemoradiotherapy, targeted therapy, immunotherapy, and other methods.

The department also treats pleural empyema, which is pus accumulation in the pleural cavity, most often due to the progression of pneumonia or a lung abscess. In some cases, pleural empyema develops due to the inadequate performance of a pleural puncture or a lung puncture. When a pathological process is detected in its early stages, thoracic surgeons use low-traumatic endoscopic techniques. In the advanced stages of pleural empyema, experts prefer open surgery, namely decortication. In some cases, after the operation, it is necessary to rinse the thorax with drainage systems.

The department's doctors are competent in surgical repair of the pectus excavatum. This congenital malformation is characterized by retraction of the sternum and ribs at various depths. Pectus excavatum occurs predominantly in males. If left unrepaired, a patient will develop secondary spinal deformities, impaired respiratory function, etc. In addition, patients with pectus excavatum often suffer from complexes due to their appearance. In most cases, thoracic surgeons perform a minimally invasive Nuss procedure, during which one or two individually adapted metal staples are inserted into the thorax under image guidance, which straighten the chest from the inside by applying tension. The Nuss procedure guarantees an excellent aesthetic outcome, minimal soft tissue trauma, and a low risk of complications. In complicated clinical cases, an open Ravitch procedure is recommended for patients.

The department specializes in the diagnostics and treatment of the following diseases:

• Benign diseases of the lungs, chest organs and mediastinum
  • Pleural empyema
  • Pleurisy
  • Pneumothorax
  • Tracheal stenosis
  • Pectus excavatum
  • Pulmonary sequestration
  • Respiratory failure
  • Chest injuries
• Malignant diseases of the lungs, thorax and mediastinum
  • Thymic cancer (thymoma)
  • Lung cancer
  • Chest wall tumors
  • Pleural mesothelioma
  • Malignant pleural effusion
  • Esophageal diseases with lung involvement
  • Lung metastases
• Other diseases

The department's surgical options include:

• Video-assisted thoracoscopic surgery (minimally invasive surgery)
• Thoracotomy (classic open surgery)
• Endoscopic interventions
  • Flexible and rigid bronchoscopy
  • Mediastinoscopy
• Nuss procedure (minimally invasive) and Ravitch procedure (open) to repair pectus excavatum
• Lung transplant
• Other methods of surgical treatment