Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome
24 November 2019
17 January 2020
08 April 2020 (online)
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.
The authors stated that no competing financial interests exist.
- 1 Pacilli M, Nataraja RM. Management of paediatric empyema by video-assisted thoracoscopic surgery (VATS) versus chest drain with fibrinolysis: systematic review and meta-analysis. Paediatr Respir Rev 2019; 30: 42-48
- 2 Schneider CR, Gauderer MW, Blackhurst D, Chandler JC, Abrams RS. Video-assisted thoracoscopic surgery as a primary intervention in pediatric parapneumonic effusion and empyema. Am Surg 2010; 76 (09) 957-961
- 3 Bender MT, Ward AN, Iocono JA, Saha SP. Current surgical management of empyema thoracis in children: a single-center experience. Am Surg 2015; 81 (09) 849-853
- 4 Lamas-Pinheiro R, Henriques-Coelho T, Fernandes S. , et al. Thoracoscopy in the management of pediatric empyemas. Rev Port Pneumol (2006) 2016; 22 (03) 157-162
- 5 Aziz A, Healey JM, Qureshi F. , et al. Comparative analysis of chest tube thoracostomy and video-assisted thoracoscopic surgery in empyema and parapneumonic effusion associated with pneumonia in children. Surg Infect (Larchmt) 2008; 9 (03) 317-323
- 6 Knebel R, Fraga JC, Amantea SL, Isolan PBS. Videothoracoscopic surgery before and after chest tube drainage for children with complicated parapneumonic effusion. J Pediatr (Rio J) 2018; 94 (02) 140-145
- 7 Velaiutham S, Pathmanathan S, Whitehead B, Kumar R. Video-assisted thoracoscopic surgery of childhood empyema: early referral improves outcome. Pediatr Surg Int 2010; 26 (10) 1031-1035
- 8 Kelly MM, Coller RJ, Kohler JE. , et al. Trends in hospital treatment of empyema in children in the United States. J Pediatr 2018; 202: 245-251.e1
- 9 Livingston MH, Cohen E, Giglia L. , et al. Are some children with empyema at risk for treatment failure with fibrinolytics? A multicenter cohort study. J Pediatr Surg 2016; 51 (05) 832-837
- 10 Griffith D, Boal M, Rogers T. Evolution of practice in the management of parapneumonic effusion and empyema in children. J Pediatr Surg 2018; 53 (04) 644-646
- 11 Redden MD, Chin TY, van Driel ML. Surgical versus non-surgical management for pleural empyema. Cochrane Database Syst Rev 2017; 3: CD010651
- 12 Kurt BA, Winterhalter KM, Connors RH, Betz BW, Winters JW. Therapy of parapneumonic effusions in children: video-assisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics 2006; 118 (03) e547-e553
- 13 Kang DW, Campos JR, Andrade Filho LdeO. , et al. Thoracoscopy in the treatment of pleural empyema in pediatric patients. J Bras Pneumol 2008; 34 (04) 205-211
- 14 Bishay M, Short M, Shah K. , et al. Efficacy of video-assisted thoracoscopic surgery in managing childhood empyema: a large single-centre study. J Pediatr Surg 2009; 44 (02) 337-342
- 15 Parelkar SV, Patil SH, Sanghvi BV. , et al. Video-assisted thoracoscopic surgery for pediatric empyema by two-port technique: a single-center experience with 167 consecutive cases. J Indian Assoc Pediatr Surg 2017; 22 (03) 150-154
- 16 Reichert M, Pösentrup B, Hecker A, Padberg W, Bodner J. Lung decortication in phase III pleural empyema by video-assisted thoracoscopic surgery (VATS)-results of a learning curve study. J Thorac Dis 2018; 10 (07) 4311-4320