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Thoracoscopy for empyema in children
H A Steinbrecher1, A S Najmaldin
1Department of Paediatric Surgery, St James's University Hospital and The General Infirmary, Leeds, England.
Insights
Thoracoscopy was evaluated for childhood empyema management. It proved ineffective for complete disease clearance in most cases, suggesting thoracotomy is a more reliable surgical option for pediatric empyema.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Empyema is a significant thoracic infection in children.
- Management often requires surgical intervention.
- The role of minimally invasive techniques like thoracoscopy is under investigation.
Purpose of the Study:
- To evaluate the effectiveness of thoracoscopy in managing pediatric empyema.
- To compare thoracoscopy outcomes with traditional thoracotomy.
Main Methods:
- Seven children with empyema underwent thoracoscopy over 19 months.
- Patients received antibiotics and imaging (ultrasound/CT) prior to procedures.
- Indications included lack of antibiotic response or loculated fluid.
Main Results:
- Thoracoscopy provided good access and clearance in only two patients.
- The remaining patients experienced difficulties with access, instrumentation, and debris removal.
- These patients subsequently required thoracotomy, with two needing decortication.
Conclusions:
- Thoracoscopy appears less effective than thoracotomy for pediatric empyema, even in early stages.
- Further research and larger studies are needed to establish thoracoscopy's role in childhood empyema treatment.
Methods:
During a 19-month period, seven children with empyema underwent thoracoscopy. The average age was 7.5 years (range, 3 to 15 years) and the duration of illness before surgery 16.5 days (range, 7 to 42 days). All patients received preoperative antibiotics, underwent ultrasound or CT scan and thoracentesis. Two patients had preoperative intercostal tube drainage. Indications for operations were lack of response to antibiotics of loculation of pleural fluid on imaging. All procedures were performed under general anesthesia with a single lumen tube.
Results:
Thoracoscopy allowed for good access and complete clearance in two patients. In the remaining patients, thoracoscopy failed to clear the disease because of difficulty with access, instrumentation, and clearance of thick debris. These patients underwent thoracotomy with two requiring decortication.
Conclusions:
This experience suggests that even in the early stage of empyema formation, thoracoscopy is not as effective as thoracotomy. Larger experience and studies are required to define the place of thoracoscopy in the management of childhood empyema.
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