Optimizing control of the pleural space.

Pleural space problems can create formidable treatment dilemmas for thoracic surgeons. Most arise as iatrogenic sequelae of lung resections, although some occur as late consequences of infection, hemothorax, or systemic inflammatory disease. Regardless of etiology, a central theme in the development and perpetuation of chronic pleural space problems is that there has been a loss of parietal-visceral pleural apposition, and this has allowed for development of an obligate space. A variety of surgical strategies aimed at reestablishment of pleural apposition and obliteration of pleural space are reviewed.