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Primary thoracoscopic treatment of empyema in children
Gordon Cohen1, Vibeke Hjortdal, Marco Ricci
1Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom. gordoncohen@yahoo.com
Insights
Primary thoracoscopic drainage and decortication significantly reduces invasive interventions, antibiotic duration, and hospital stays for pediatric empyema compared to conventional management.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Pediatric empyema treatment strategies are debated.
- Conventional management involves chest drain insertion and antibiotics.
- Primary thoracoscopic drainage and decortication is an alternative approach.
Purpose of the Study:
- To compare conventional management with primary thoracoscopic drainage and decortication in pediatric empyema.
- To evaluate treatment outcomes, including invasiveness and duration.
Main Methods:
- Retrospective comparison of 54 patients (conventional) and 21 patients (thoracoscopic).
- Conventional: chest drain insertion under general anesthesia + IV antibiotics.
- Thoracoscopic: primary thoracoscopic drainage and decortication + antibiotics.
Main Results:
- Thoracoscopic group had fewer interventions (1.0 vs 1.26 per patient).
- Significantly shorter IV antibiotic duration (7.6 vs 18.2 days), chest tube drainage (4.0 vs 10.2 days), and hospital stays (7.4 vs 15.4 days).
- No open thoracotomies in the thoracoscopic group, versus 39% in the conventional group.
Conclusions:
- Thoracoscopic surgery is supported as a primary treatment for pediatric empyema.
- This approach offers benefits over conventional treatment regarding treatment duration and surgical invasiveness.
- Further prospective studies may be warranted to confirm these findings.
Objective:
The optimal treatment of pediatric empyema remains controversial. The objective of this study is to compare the use of conventional management versus primary thoracoscopic drainage and decortication in children with empyema.
Methods:
Conventional management has consisted of chest drain insertion under general anesthesia plus intravenous antibiotics. Thoracoscopic drainage and decortication has consisted of primary thoracoscopic drainage and decortication plus antibiotics. The clinical course of 54 patients treated conventionally between 1989 and 1997 was compared with that of 21 patients treated by means of thoracoscopic drainage and decortication between September 2000 and September 2001.
Results:
Results of the study demonstrated that patients in the drainage-decortication group had fewer invasive interventions per patient than those in the conventional management group (1.0 vs 1.26). Patients undergoing thoracoscopic drainage and decortication also had significantly shorter durations of intravenous antibiotic therapy (7.6 +/- 1.2 vs 18.2 +/- 7.5 days), chest tube drainage (4.0 +/- 0.5 vs 10.2 +/- 6.1 days), and hospital stays (7.4 +/- 0.8 vs 15.4 +/- 7.4). Moreover, there were no open thoracotomies and decortications in the thoracoscopic drainage and decortication group, whereas in the conventional management group 39% (21/54) of patients underwent an open procedure.
Conclusion:
Although the 2 groups were not prospectively randomized and they were treated in different time periods, the results of this study support the use of thoracoscopic surgery as the primary therapeutic modality in children presenting with pleural empyema. This strategy appears to offer significant benefits over conventional treatment in terms of duration of treatment and the need for more invasive surgery.