Early thoracoscopy for the management of empyema in children

Empyema is a significant cause of morbidity in children. Treatment is still a matter of controversy between surgical and non-surgical options. We reviewed our experience with the use of video-assisted thoracoscopy (VATS) in the treatment of empyema and proposed an algorithm.

We retrospectively reviewed all the pediatric patients recorded at our institution from January 2003 to December 2007 who were diagnosed with empyema and treated by surgery.

23 children with empyema were treated with VATS during the review period. Mean age was 58.9 months and the duration of symptoms before admission was 6.1 days. All patients had a parapneumonic empyema treated by preoperative antibiotics (17/23 by parenteral antibiotics and 6/23 by oral antibiotics). Pre-operative imaging included chest X-ray in all cases and ultrasonography in all cases but one and computed tomography in 3 (13%). Our 23 patients underwent VATS within 5.3 days of hospitalisation, the most recent patients within 2 days. Chest tubes were removed after 2.7 days (range 2 to 4) resulting in a postoperative length of stay (LOS) of 10.3 days (range 6 to 28). Total LOS was 13.3 days (range 8 to 30). One patient required a conversion to thoracotomy. One patient required prolonged mechanical ventilation due to a severe myopathy during the post operative course, but there were no complications or deaths. Followup was available for all patients who all remained symptom-free and suffered no recurrence (clinical and radiological).

Early thoracoscopy for empyema in children is safe and efficient in the short and mid-term outcome. We describe an algorithm based on our initial experience and review the literature for the management of empyema in children.