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Updated: Jul 5, 2026
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Thoracoscopy in the treatment of pleural empyema in pediatric patients
Davi Wen Wei Kang1, José Ribas Milanez de Campos, Laert de Oliveira Andrade Filho
1Hospital Israelita Albert Einstein, Hospital Jaraguá, São Paulo, Brazil. daviwwkang@ig.com.br
Insights
Early thoracoscopy improves outcomes for pediatric pleural empyema. This minimally invasive surgery reduces complications and hospital stays compared to delayed interventions, offering better clinical results for children.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Pleural empyema management in children remains a challenge.
- Delayed surgical intervention is common, especially with complex cases.
- Current treatment guidelines often lack consensus on optimal timing.
Purpose of the Study:
- To evaluate the effectiveness of thoracoscopy in treating pediatric pleural empyema.
- To compare outcomes of early versus delayed surgical intervention.
- To identify factors influencing treatment success in pediatric patients.
Main Methods:
- Retrospective analysis of 117 pediatric patients treated for pleural empyema.
- Procedures included mediastinoscopy and video-assisted thoracoscopy.
- Surgical indication criteria included treatment failure, severe sepsis, or loculated effusions.
Main Results:
- 117 thoracoscopies performed on patients aged 5 months to 17 years.
- Mean thoracic drainage: 9 days; mean hospitalization: 16.4 days.
- Mortality: 0.8%; persistent fistula: 28%; conversion to open thoracotomy: 6%.
Conclusions:
- Early thoracoscopy in pediatric pleural empyema leads to better clinical outcomes.
- Decreased morbidity, mortality, earlier chest tube removal, and shorter hospital stays observed.
- Timely surgical intervention is crucial for improved patient response and recovery.
Objective:
To evaluate the results of thoracoscopy for the treatment of pleural empyema in pediatric patients.
Methods:
A retrospective study of 117 patients who underwent mediastinoscopy or video-assisted thoracoscopy for pleural empyema treatment. General anesthesia and single-lumen oral intubation were used. Surgery was indicated when there was pleural effusion and no clinical and radiological response to clinical treatment (antibiotics, physiotherapy and thoracocentesis) or severe sepsis, together with loculated pleural effusion (confirmed through ultrasound or computed tomography of the chest).
Results:
Between February of 1983 and July of 2006, 117 thoracoscopies were performed in patients ranging in age from 5 months to 17 years (mean, 4 years). Mean time for thoracic drainage was 9 days (range, 2-33 days), and mean period of hospitalization was 16.4 days (range, 4 to 49 days). One patient (0.8%) died after surgery, and persistent fistula was observed in 33 patients (28%). In 7 cases (6%), open thoracotomy with pulmonary decortication was performed due to the disposition of the empyema.
Conclusions:
Management of pleural empyema in this age bracket is still controversial, and surgical indication is often delayed, particularly when there are multiple loculations or severe sepsis. Early thoracoscopy yields a better clinical outcome for pediatric patients with pleural empyema, with apparent decreased morbidity and mortality, earlier chest tube removal, earlier hospital discharge and improved response to antibiotic therapy.
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