Toracoscopia no tratamento do empiema pleural em pacientes pediátricos

Kang, Davi Wen Wei; Campos, José Ribas Milanez de; Filho, Laert de Oliveira Andrade; Engel, Fabiano Cataldi; Xavier, Alexandre M.; Macedo, Maurício; Meyer, Karine Furtado

doi:10.1590/s1806-37132008000400004

Cited by 17 publications

(7 citation statements)

References 25 publications

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“…It has been proven that the earlier the intervention and debridement the better are the results. [578] Hence, primary VATS is favored over secondary procedure due to superior results. As management protocols are evolving, earlier referral by pediatricians is resulting in larger number of patients undergoing primary surgery rather than a tube ICD and secondary VATS.…”

Section: Discussionmentioning

confidence: 99%

Video-Assisted thoracoscopic surgery for pediatric empyema by two-port technique: A single-center experience with 167 consecutive cases

Parelkar¹,

Patil²,

Sanghvi³

et al. 2017

J Indian Assoc Pediatr Surg

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Background/Purpose:The aim of our study is to determine efficacy, safety, and feasibility of video-assisted thoracoscopic surgery (VATS) in childhood empyema with a technique of only two ports and open instruments at a tertiary care center in India.Methods:This is a retrospective study of patients below 18 years, with empyema presenting to the Department of Pediatric Surgery of a Tertiary Care Referral Hospital in India, over a period of 9 years who underwent VATS decortication. Only two ports with open surgical instruments were used. The patients were assessed on the basis of mean duration of preoperative symptoms, duration of surgery, average blood loss, postoperative pain relief, complications, and need for redo surgery.Results:A total of 97 patients underwent primary VATS decortications without inserting an intercostal drainage (ICD) tube and 70 patients as a secondary procedure after ICD tube was inserted. Mean duration of symptoms was 11 days. The average blood loss during surgery was estimated to be 170 cc. The mean duration of surgery was 90 min. The most common postoperative complication was air leak seen in 19.16% of patients. Minor leaks usually settled by 24 h. In eight patients, a negative suction had to be applied to the ICD tube for persistent air leak. The average length of postoperative stay was 4 days. Two patients required a repeat open decortication procedure due to nonresolution of symptoms and poor lung expansion after VATS. Patients had minimal pain and excellent cosmetic outcome after VATS.Conclusion:Two-port VATS decortication procedure is as feasible and effective as three-port procedure for decortication with better cosmetic result and pain relief.

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Section: Discussionmentioning

confidence: 99%

Video-Assisted thoracoscopic surgery for pediatric empyema by two-port technique: A single-center experience with 167 consecutive cases

Parelkar¹,

Patil²,

Sanghvi³

et al. 2017

J Indian Assoc Pediatr Surg

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“…The occurrence of complications can explain the longer LOS in some cases. 17 , 30 The frequency of therapeutic failure was lower than that reported in a study that did not exclude patients with empyema in the organizing phase or with necrotizing pneumonia, two factors that are known to be related to a higher occurrence of complications and a longer LOS. 16 …”

Section: Discussionmentioning

confidence: 85%

“…There are studies that report the LOS, the duration of chest drainage, the success rate, and the frequency of complications, but with no comparison group regarding the timing of thoracoscopy. 13 - 17 , 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Parapneumonic pleural effusion: early versus late thoracoscopy

Pereira¹,

Alvim

Andrade

et al. 2017

J. bras. pneumol.

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Objective: To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications.Methods: This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization.Results: We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001). There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6%) had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths.Conclusions: Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion.

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“…(13) metaanaliz çalışmalarında, cerrahi yapılan çocuk ampiyem olgularında antibiyotik kullanımı ve hastanede kalma sürelerinin belirgin azaldığını bildirmişler. Medikal tedavide ısrar edilen hastalarda hem cerrahi güç olmakta hem de cerrahi sonrası komplikasyon artmaktadır (6,14) . Chung ve ark.…”

Section: Gereç Ve Yöntemunclassified

“…Klinik bulgular ve cerrahi zamanlamaya göre hastaları 2 haftadan az, 2-4 hafta ve 4 haftadan uzun olmak üzere 3 gruba ayırdıklarında ilk iki grupta fark görmediklerini fakat 4 haftadan sonra VATS debridman ve dekortikasyon yapılan hastalarda ameliyat süresinin uzadığını ve komplikasyonların arttığını bildirmişler. Günümüzde çocuk ampiyem hastalarında erken VATS debridman ve dekortikasyon görüşü artmaktadır (6,14,16) .…”

Section: Gereç Ve Yöntemunclassified