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Video-Assisted Thoracoscopic Surgery Versus Tube Thoracostomy with Fibrinolytics for Treatment of Empyema in

Maria Enrica Miscia1,2, Giuseppe Lauriti1,2, Dacia Di Renzo2

  • 1Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy.

Children (Basel, Switzerland)
|September 27, 2025
PubMed

Insights

Video-Assisted Thoracoscopic Surgery (VATS) significantly reduces hospital stays and improves outcomes for pediatric empyema compared to fibrinolytics. This meta-analysis confirms VATS as a superior treatment option for children with empyema.

Area of Science:

  • Pediatric Thoracic Surgery
  • Minimally Invasive Procedures
  • Evidence-Based Medicine

Background:

  • Traditional treatment for pediatric empyema involved tube thoracostomy with intra-pleural fibrinolytics, as recommended in 2005.
  • Emerging evidence suggests Video-Assisted Thoracoscopic Surgery (VATS) offers superior outcomes, including reduced length of hospital stay (LOS).
  • This study addresses the need for a direct comparison between VATS and fibrinolytics for pediatric empyema management.

Purpose of the Study:

  • To compare the length of hospital stay (LOS) between VATS and fibrinolytics in pediatric empyema treatment.
  • To evaluate secondary post-operative outcomes, including fever duration, oxygen support, chest tube removal time, and complication rates.
  • To provide evidence-based recommendations for the optimal surgical approach in pediatric empyema.

Main Methods:

  • A systematic literature search was conducted across major databases (PubMed, Cochrane, Web of Science, Scopus) following PRISMA guidelines.
  • Randomized controlled trials (RCTs) comparing VATS and fibrinolytics for pediatric empyema were identified and analyzed.
  • Meta-analysis was performed using RevMan 5.4, with data expressed as mean ± standard deviation (SD).

Main Results:

  • VATS significantly reduced LOS compared to fibrinolytics (9.1 ± 1.8 vs. 11.5 ± 2.5 days, p=0.05).
  • VATS was associated with shorter postoperative fever duration (4.2 ± 0.8 vs. 6.9 ± 4.6 days, p=0.007) and earlier chest tube removal (5.0 ± 2.6 vs. 9.5 ± 3.3 days, p=0.01).
  • No significant differences were observed between groups for other secondary outcomes.

Conclusions:

  • Video-Assisted Thoracoscopic Surgery (VATS) demonstrates superior outcomes for pediatric empyema compared to tube thoracostomy with fibrinolytics.
  • VATS offers significant benefits, including shorter hospital stays and reduced fever duration.
  • Further randomized controlled trials are warranted to solidify these findings and guide clinical practice.

Keywords:
childrenempyemafibrinolyticmeta-analysisrandomized controlled studiessystematic reviewtube thoracostomyvideo-assisted thoracoscopic surgery

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