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Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
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Thoracoscopic debridement for empyema thoracis
Robert Thomas Peters1, Dakshesh H Parikh1, Michael Singh1
1Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
Journal of Pediatric Surgery
|March 10, 2020
Summary
Early thoracoscopic debridement (TD) is effective for childhood empyema, achieving good lung expansion. However, severe cases with pulmonary necrosis (PN) and bronchopleural fistula (BPF) may require thoracotomy.
Area of Science:
- Pediatric surgery
- Thoracic surgery
- Pulmonology
Background:
- Childhood empyema incidence is rising, often associated with pulmonary necrosis (PN).
- Early intervention strategies for pediatric empyema are crucial.
Purpose of the Study:
- To review the success rate of early thoracoscopic debridement (TD) in pediatric empyema.
- To evaluate TD outcomes in the context of increasing PN incidence.
Main Methods:
- Retrospective data collection from 106 pediatric patients undergoing thoracoscopic intervention (2010-2016).
- Analysis of TD success rates, including conversions to thoracotomy.
- Exclusion of 20 severe PN/Bronchopleural Fistula (BPF) cases requiring alternative surgical approaches.
Main Results:
- The overall success rate of TD was 88% (93/106), with 3 conversions to thoracotomy.
- 10 patients required subsequent minithoracotomy for PN/BPF, managed with a Serratus anterior digitation flap.
- No significant difference in success rate compared to previous studies.
Conclusions:
- Primary TD offers excellent outcomes for pediatric empyema, ensuring adequate drainage and lung expansion.
- Failures were primarily linked to PN/BPF, necessitating thoracotomy and flap reconstruction.
- Increasing necrotizing pneumonia incidence may contribute to higher rates of TD failure.
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