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Early definitive intervention by thoracoscopy in pediatric empyema
C M Merry1, A J Bufo, R S Shah
1Section of Pediatric Surgery, University of Tennessee, Le Bonheur Children's Medical Center, Memphis 38105, USA.
Journal of Pediatric Surgery
|February 18, 1999
Summary
Early thoracoscopic intervention for pediatric empyema offers a safe and effective treatment, reducing the need for invasive thoracotomy and lengthy chest tube drainage. This minimally invasive approach shows promising results in managing fibrinopurulent empyema.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Empyema is a significant thoracic infection in children.
- Traditional treatment often involves thoracotomy or prolonged chest tube drainage, associated with considerable morbidity.
- Early intervention strategies are crucial for improved patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of early thoracoscopic intervention for pediatric empyema.
- To assess the outcomes of thoracoscopic debridement and drainage in children with fibrinopurulent empyema.
Main Methods:
- Nineteen children with empyema underwent early thoracoscopic intervention between 1992 and 1997.
- The procedure involved disrupting loculi, evacuating debris, and chest tube placement via an irrigating laparoendoscope.
- Intervention was performed during the fibrinopurulent stage of empyema.
Main Results:
- Patients ranged from 11 months to 16 years old, with most cases being parapneumonic.
- Mean time to thoracoscopy was 4.6 days post-admission; chest tubes were removed after a mean of 2.9 days.
- Mean hospital stay was 10.3 days, with no reported complications. The procedure was well-tolerated and efficient.
Conclusions:
- Thoracoscopy effectively eliminates the morbidity associated with thoracotomy and reduces the need for prolonged chest tube drainage.
- Early thoracoscopic intervention is a safe and viable first-line treatment for pediatric fibrinopurulent empyema.
- This minimally invasive approach offers significant benefits in managing pediatric empyema.