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International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
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International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

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Thoracoscopy in the management of pediatric empyemas

R Lamas-Pinheiro1, T Henriques-Coelho1, S Fernandes2

  • 1Pediatric Surgery Department, Hospital São João, Faculty of Medicine, Porto, Portugal.

Revista Portuguesa De Pneumologia
|January 26, 2016
PubMed

Insights

Thoracoscopic surgery for pediatric empyema is safe and effective, significantly reducing the need for thoracotomy after a learning period. While reoperation rates may increase, especially with necrotizing pneumonia, thoracoscopy offers a viable treatment.

Area of Science:

  • Pediatric surgery
  • Thoracic surgery
  • Infectious diseases

Background:

  • Empyema treatment in children is evolving.
  • Thoracoscopy is increasingly adopted for pediatric empyema management.
  • Assessing the feasibility, efficacy, and safety of thoracoscopy in children is crucial.

Purpose of the Study:

  • To evaluate the feasibility, efficacy, and safety of thoracoscopy for pediatric empyema.
  • To compare outcomes before and after a learning curve for thoracoscopic empyema treatment.
  • To determine the rate of thoracotomy avoidance and reintervention.

Main Methods:

  • Retrospective review of clinical files for 91 children undergoing primary thoracoscopy for empyema (2006-2014).
  • Analysis of demographic, clinical, and surgical data.
  • Comparison of outcomes between pre-learning curve (period 1) and post-learning curve (period 2) periods.

Main Results:

  • Thoracoscopy was performed in 91 children (median age 4 years).
  • Conversion to thoracotomy decreased from period 1 to period 2 (62% vs. 92% avoidance, p=0.001).
  • Reoperation was needed in 6.6% of cases, with necrotizing pneumonia associated with higher reintervention risk.

Conclusions:

  • Thoracoscopic approach for pediatric empyema is feasible and safe, significantly reducing thoracotomies post-learning curve.
  • While reintervention rates may increase, thoracoscopy is effective in most cases.
  • Necrotizing pneumonia is a potential contraindication and associated with higher reintervention risk.
Abstract

Keywords:
ChildrenConversionEmpyemaReinterventionThoracoscopy

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