Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome

Abstract

Objectives The aim of this study was to observe outcomes of early decortication in a treatment of pleural empyema using video-assisted thoracoscopic surgery (VATS). Methods The case records of 21 pediatric patients who underwent VATS for empyema between 2009 and 2019 were retrospectively reviewed. Patients were observed based on demographic, laboratory, and clinical data, as well as treatment outcomes. Results Out of a total of 59 patients treated for pleural empyema, 21 (10 male and 11 female) children with a median age of 5 years (interquartile range [IQR] 2.8; 6.0) received VATS. The empyema was classified as stage I in 2 patients (9.5%), stage II in 4 patients (19%), and stage III in 15 patients (71.5%). Median surgical time was 60 minutes (IQR 50; 90). There were 2 (9.5%) postoperative complications and 1 recurrence (4.8%). Children treated in stages I and II showed significantly better postoperative results compared with the children treated in stage III. Length of hospital stay (8 vs. 10 days; p = 0.01), length of intensive care unit stay (1 vs. 5 days; p < 0.001), duration of chest tube drainage (4 vs. 6 days; p = 0.043), duration of postoperative fever (1.5 vs. 4 days; p = 0.001), and surgical time (40 vs. 70 minutes; p < 0.001) were significantly shorter in children operated in stages I and II than in stage III. Conclusion Early decortication using a VATS is a successful, effective, and easily performed surgical method in the treatment of pediatric pleural empyema, as well as a method that significantly improves recovery time and shortens the hospital stay.

Risk factors associated with surgical intervention in childhood pleural tuberculosis

“…On the one hand, the appropriate stage of empyema for surgical treatment required further investigation 19 . For example, Pogorelić et al found that in the early stage of pleural empyema, video-assisted thoracic surgery could improve the outcome of pediatric patient 20 . In contrast, some authors recommended intrapleural fibrinolytic treatment in patients with stage 1 and 2 empyema 21 .…”

Application of thoracoscopic surgery in patients with pleural empyema

“…), 10 момчета и 11 момичета, с емпием на плеврата през периода между 2009 г. и 2019 г. в гр. Сплит, Хърватска (12). В първи стадий на заболяването са две деца, във втори -четири деца, а в трети -15 деца.…”

Persistent pulmonary air leak in the pediatric intensive care unit: Characteristics and outcomes

“…PAL can complicate spontaneous pneumothorax, empyema, pulmonary infection, barotrauma, chest trauma, lung surgery, and other underlying lung diseases. 2,5,6 Specifically in children, necrotizing pneumonia and empyema are common causes, and their incidences have increased over recent decades . 7,8 Data from studies of adults show that some air leaks are prolonged, although many resolve spontaneously with conservative management.…”

“…PAL may be caused by alveolar‐pleural fistula or bronchopleural fistula (BPF); these are not always distinguishable in the clinical setting. PAL can complicate spontaneous pneumothorax, empyema, pulmonary infection, barotrauma, chest trauma, lung surgery, and other underlying lung diseases 2,5,6 . Specifically in children, necrotizing pneumonia and empyema are common causes, and their incidences have increased over recent decades 7,8 .…”