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Published on: December 29, 2014
Thoracoscopic decortication in infants and children
1Columbia-HealthONE Presbyterian, St. Luke's Hospital, 1601 East Nineteenth Avenue, Suite 5200, Denver, CO 80218, USA.
Background:
The treatment of pediatric empyemas remains controversial. While thoracentesis and tube thoracostomy appear adequate for relatively benign organisms, virulent bacteria cause thick fibrinous pleural peels entrapping the lung. Open thoracotomies have been effectively used for decortication but are painful.
Methods:
We report the use of minimally invasive thoracoscopic decortication in 12 patients (mean age 5 years). All failed conventional management with persistent fever, increasing oxygen requirement, recurrent effusion, and pleural consolidation; 5- and 10-mm trocars were used and complete decortication was accomplished.
Results:
Ten of 12 patients were afebrile by 72 h and discharged 4-12 days after surgery. Eleven of 12 patients had clear chest x-rays by 1 month.
Conclusion:
Thoracoscopic decortication is a safe and effective means of treating pediatric empyemas.
Insights
Minimally invasive thoracoscopic decortication effectively treats pediatric empyemas. This procedure offers a safe and successful alternative for children with complicated pleural infections unresponsive to conventional therapies.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Pediatric empyema treatment is controversial, especially for infections caused by virulent bacteria.
- Thick fibrinous pleural peels can entrap the lung, necessitating effective drainage and lysis.
- While open thoracotomy is effective for decortication, it is associated with significant pain.
Purpose of the Study:
- To evaluate the safety and efficacy of thoracoscopic decortication in pediatric empyema.
- To assess the outcomes of minimally invasive surgery in children who failed conventional management.
Main Methods:
- Retrospective case series of 12 pediatric patients (mean age 5 years) with empyema.
- All patients had failed conventional treatments including persistent fever and pleural consolidation.
- Minimally invasive thoracoscopic decortication was performed using 5- and 10-mm trocars.
Main Results:
- Ten of 12 patients became afebrile within 72 hours post-surgery.
- Hospital discharge occurred between 4-12 days after the procedure.
- Eleven of 12 patients demonstrated clear chest X-rays by one month post-thoracoscopy.
Conclusions:
- Thoracoscopic decortication is a safe and effective treatment for pediatric empyemas.
- Minimally invasive approach provides successful outcomes for complicated pleural infections.
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