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Thoracoscopic decortication as first-line therapy for pediatric parapneumonic empyema. A case series
K W Kercher1, R J Attorri, J D Hoover
1Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA. kent.kercher@umassmed.edu
Insights
Early thoracoscopic decortication for pediatric parapneumonic empyema is effective. This minimally invasive approach in children reduces chest tube duration and hospitalization, leading to faster recovery.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Pulmonology
Background:
- Refractory empyema in children historically prompted early thoracotomy.
- Parapneumonic empyema requires prompt and effective pleural space management.
Purpose of the Study:
- To evaluate the efficacy of thoracoscopic decortication at initial chest tube placement for pediatric parapneumonic empyema.
- To compare outcomes between early thoracoscopic decortication and chest tube alone.
Main Methods:
- Retrospective review of 16 pediatric patients with parapneumonic empyema.
- Group 1: Thoracoscopic decortication and tube thoracostomy (n=13).
- Group 2: Tube thoracostomy alone (n=3).
Main Results:
- Thoracoscopic decortication operative time averaged 81 minutes with no complications.
- Chest tubes removed by postoperative day 4 in the thoracoscopy group.
- Mean hospital stay was 8.3 days for thoracoscopic decortication versus 16.6 days for tube thoracostomy alone.
- Fewer subsequent procedures were needed in the thoracoscopy group.
Conclusions:
- Thoracoscopic decortication is a safe and effective early treatment for pediatric parapneumonic empyema.
- Facilitates pleural space visualization, evacuation, and decortication.
- May reduce chest tube duration, hospitalization, and improve clinical recovery.
Study Objectives:
Previous articles have promoted the early use of thoracotomy and decortication for refractory empyema. This study examines thoracoscopy and decortication at the time of initial chest tube placement in pediatric patients with parapneumonic empyema.
Design:
We reviewed the medical records of 16 consecutive patients who were children with parapneumonic empyema.
Results:
Thirteen children (group 1) underwent thoracoscopic decortication and tube thoracostomy as their initial operative procedures; 3 children (group 2) had tube thoracostomy alone. In both groups, chest tubes were removed prior to their discharge to home. The mean (+/- SD) operative time for thoracoscopy was 81 +/- 19 min with no complications. On average, chest tubes were removed by postoperative day 4. The mean time to discharge was 8.3 days. Two children eventually required lobectomy. The mean operative time for chest tube placement alone was 21 +/- 3 min. Children required chest tube drainage for an average of 12.3 days. The mean time to discharge was 16.6 days. Two patients required a total of five additional operative procedures, including two additional chest tube placements, two open decortications, and one lobectomy.
Conclusions:
Thoracoscopic decortication is effective in the early treatment of pediatric parapneumonic empyema. It facilitates visualization, evacuation, and mechanical decortication of the pleural space with no additional morbidity and may lead to reduced time for chest tube drainage, shorter hospitalization, and more rapid clinical recovery.