Surgical versus non-surgical management of pleural empyema

The purpose of this study was to compare the efficacy of thoracoscopic drainage with open drainage of empyema in children. A retrospective case history audit was done of children presenting to a single major paediatric centre who underwent thoracoscopy drainage and decortication or open decortication and drainage (thoracotomy) between January 2000 and September 2002. Time to resolution of infection, duration of intercostal catheter (ICC) drainage, postoperative morphine requirements, and length of hospital admission were compared as primary measures of outcome. Thirty-three patients, 17 male and 16 female, aged between 1 month and 21 years were included in the study. Median age at surgery was 2.6 years. The location of the empyema was right-sided in 17 patients and left-sided in 16 patients. The empyema was drained by thoracoscopy in 11 patients, and 22 patients underwent thoracotomy. Two patients had thoracoscopy converted to thoracotomy for late-stage disease requiring greater surgical access. There were no differences between treatment groups with respect to duration of ICC drainage (p=0.6), duration of fever (p=0.6), length of stay (p=0.9), or postoperative morphine use (p=0.2). However, overall pain scores were lower in the thoracoscopy group, particularly on days 2 and 3; this approached statistical significance (p=0.07). This study has demonstrated that thoracoscopic drainage is an effective procedure for treating empyema in children. It is less invasive than open thoracotomy and is associated with less patient discomfort and less severe pain as measured by objective pain scores. We advocate thoracoscopic drainage for the majority of patients with empyema, except for those with advanced disease.

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“…There have been no paediatric prospective randomised trials to date. Large prospective trials and multicentre work are needed [5].…”

Section: Discussionmentioning

confidence: 99%

Comparison of thoracoscopic drainage with open thoracotomy for treatment of paediatric parapneumonic empyema

et al. 2005

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“…A recent Cochrane review concluded that for patients with fibrinopurulent or early organizing empyemas, VATS is superior to pleural drainage combined with fibrinolytics [56]. However, most studies in this database are retrospective and only one matched the inclusion criteria.…”

Section: Treatmentmentioning

confidence: 99%

Complicated parapneumonic effusion and empyema: Pleural decortication and video-assisted thoracic surgery

Luh

Hsu²,

Chen³

2008

Curr Infect Dis Rep

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Complicated parapneumonic effusion or empyema, in which the fluid becomes more exudative, develops in 10% to 20% of patients with parapneumonic effusions. Early diagnosis and effective treatment strategies are required. New treatment strategies such as fibrinolytic therapy and decortication or debridement through video-assisted thoracoscopic surgery, have changed the choice of treatment for different stages of empyema or complicated pleural effusion. This review discusses the definition, clinical presentations, diagnosis, and treatment of these conditions, focusing on the value and comparison of video-assisted thoracoscopic surgery decortication and fibrinolytic therapies.

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“…Surgery was associated with a shorter hospital stay and shorter drainage times, but in light of the MIST 1 negative results and because of methodologic problems, replication of the study is needed. A Cochrane review evaluating surgical versus nonsurgical treatment of empyema in 2002 [110] included only one study (as cited previously [109]), questioned the validity and size of the study, and concluded that further randomized trials were needed to address this question.…”

Section: Surgical Treatmentmentioning

confidence: 99%