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Thoracoscopy in the management of empyema in children
1Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908.
Insights
Early thoracoscopy offers a minimally invasive alternative for treating pediatric empyema. This approach effectively clears the pleural space, potentially avoiding open surgery and reducing patient morbidity.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Acute empyema in children often necessitates open surgical procedures like drainage or decortication.
- These traditional open surgeries can lead to significant patient morbidity.
- Alternative, less invasive treatments are sought to improve outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of early thoracoscopic adhesiolysis and pleural debridement for pediatric acute empyema.
- To determine if thoracoscopy can obviate the need for open thoracotomy in this patient population.
Main Methods:
- A retrospective review of 9 children with acute empyema who underwent early thoracoscopy.
- All patients had failed initial antibiotic and chest tube drainage treatment.
- Procedures were performed under general anesthesia, focusing on adhesiolysis and debridement.
Main Results:
- Eight of nine patients recovered successfully with thoracoscopy and a single drainage tube.
- Average tube drainage duration was 8.4 days, and average postoperative hospital stay was 13.4 days for recovered patients.
- No complications occurred, and no further surgical intervention was required for the recovered patients.
Conclusions:
- Early thoracoscopy is a safe and effective minimally invasive treatment for pediatric acute empyema with loculated collections.
- Thoracoscopic visualization enables thorough debridement and adhesiolysis, optimizing drainage.
- This approach may eliminate the need for open drainage or decortication in pediatric empyema cases.
Abstract:
Many pediatric surgeons advocate early open drainage or decortication for children with acute empyema. Unfortunately, such procedures can be associated with significant morbidity. Since 1981, we have used early thoracoscopic adhesiolysis and pleural debridement as an alternative to open thoracotomy in 9 children with acute empyema. The average age was 7.8 +/- 1.8 years (range, 2 to 16). All patients had failed initial treatment, which included antibiotics and chest tube drainage. All procedures were performed under general anesthesia. Following thoracoscopy, 8 of the 9 patients were managed with a single drainage tube and the average duration of tube drainage was 8.4 +/- 1.4 days. One patient died of underlying leukemia. Of the 8 patients who recovered, the average postoperative hospital stay was 13.4 +/- 2.9 days. No complications resulted from the thoracoscopies and there was no need for further surgical intervention in any of these patients. We conclude that thoracoscopy allows for minimally invasive, yet effective treatment of acute empyema with loculated collections. Thoracoscopic visualization of the pleural cavity permits efficient debridement, thorough adhesiolysis, and optimal placement of drainage tubes. Since we have begun using early thoracoscopy in the treatment of pediatric empyema, open drainage or decortication has not been required in any of these patients. Thoracoscopy is a useful adjunct in the treatment of empyema in children and its early application may eliminate the need for decortication.