A comparative study of uniportal video-assisted thoracic surgery versus thoracotomy in the treatment of TB empyema.

BACKGROUND: Chronic TB empyema is a serious complication of TB that often requires surgery because drug penetration into fibrotic pleural tissue is poor. We compared uniportal video-assisted thoracic surgery (VATS) and thoracotomy for pleural decortication. METHODS: We retrospectively analysed 112 patients with chronic TB empyema who underwent surgical treatment between 2020 and 2024. Thoracic morphometric changes were assessed using pre- and postoperative computed tomography, and factors associated with postoperative thoracic expansion were explored. RESULTS: Of the 112 patients, 65 underwent thoracotomy and 47 uniportal VATS. The overall excellent/good outcome rate was 91.9%, based on postoperative lung re-expansion, residual empyema cavity and residual fibrous pleural plaque. Compared with thoracotomy, uniportal VATS was associated with less intraoperative blood loss (151.8 ± 127 vs. 278 ± 231 mL, P < 0.001) and a shorter postoperative hospital stay (8.2 ± 3.7 vs. 9.9 ± 3.1 days, P = 0.002). Both groups showed significant postoperative improvement in thoracic morphometric measurements. Older age was associated with poorer postoperative thoracic expansion. CONCLUSION: In this retrospective single-centre cohort, uniportal VATS was associated with more favourable perioperative outcomes than thoracotomy, with comparable short-term radiographic recovery.