Thoracoscopic Decortication: First-Line Therapy for Pediatric Empyema

Abstract

Video-assisted thoracoscopic surgery (VATS) has become a popular and well-refined procedure. It has several advantages over open thoracotomy in terms of invasiveness and cosmetics. The aim of this study is to consider if VATS can serve as primary management for pediatric empyema. Between October 2000 and December 2002, 13 children with empyema receiving VATS were retrospectively reviewed. Of them, 5 had tube thoracostomy before VATS intervention (group T), and 8 had VATS as the initial treatment (group V). Their mean (± SD) age of groups V and T were 5.75 ± 4.43 and 4.0 ± 1.58 years, respectively. The children of group V had a shorter length of hospital stay (group V 10.7 ± 3.54 days; group T 28.2 ± 8.32 days), a shorter period of chest tube drainage (group V 5 ± 1.87 days; group T 25 ± 11.08 days), less transfusion (group V 0.4 ± 0.17 units; group T 0.9 ± 0.27 units) and less radiation exposure (group V 10.3 ± 3.49; group T 23.4 ± 11.64). No mortality was noted in the entire series. We conclude that primary VATS is a safe, effective and definitive method which can serve as first-line therapy for children with empyema.

Less is best? The impact of urokinase as the first line management of empyema thoracis

“…Thoracotomy and to a lesser extent, thoracoscopy are not without significant long-term complications. Whilst some authors have indicated that early thoracoscopy is beneficial, in our own experience we reserve it for those cases that urokinase failed in alleviating the condition [23]. Other centres have used tissue plasminogen activator (tPA) with similar success [24].…”

Parapneumonic Effusion and Empyema in Children: Retrospective Review of the duPont Experience

“…26 Management strategies have ranged from conservative treatment of parapneumonic empyema 27 to thoracoscopic decortication, the first-line therapy for pediatric empyema. [28][29][30] All patients who needed a CT scan to determine if they had intrapulmonary or extrapulmonary disease had a higher likelihood of needing a thoracoscopy. If thoracoscopy was done within 48 hours of admission, a significantly shorter length of stay was documented.…”

How Should We Manage Empyema: Antibiotics Alone, Fibrinolytics, or Primary Video-Assisted Thoracoscopic Surgery (VATS)?

“…Six studies, including two randomized trials 37,65 have reported on children treated by VATS in the 2002-2006 time frame and are summarized in Table 2. 37,40,[65][66][67][68] In these studies postoperative chest drainage averaged 2.8 to 5.0 days; hospital stay 5.8 to 8.4 days postprocedure, and success rate (judged as no further surgical procedure) ranged from 83 to 100%. The prolonged operative time and significant blood loss reported in early VATS studies are now rare and operative morbidity is low.…”