Is thoracoscopically aided pleural debridement advantageous in children?

Area of Science:

• Pediatric Surgery
• Thoracic Surgery
• Pulmonology

Background:

• Thoracic empyema presents a range of pleural inflammation, from simple effusions to thick, constricting empyema necessitatis.
• Effective management of complicated pediatric empyema remains a clinical challenge.

Purpose of the Study:

• To evaluate the efficacy and benefits of thoracoscopically aided pleural debridement (TAPD) in pediatric patients with complicated empyema.
• To compare TAPD outcomes with traditional treatment modalities.

Main Methods:

• Retrospective review of 26 pediatric patients diagnosed with empyema over six years.
• Analysis of treatment strategies including antibiotics alone, tube thoracostomy, open thoracotomy, and TAPD.
• Assessment of clinical data, radiographic findings, length of stay, and postoperative outcomes.

Main Results:

• Children treated with TAPD (n=7) had an average length of stay of 12 days and average postoperative chest tube use of 6 days.
• Compared to other methods, TAPD resulted in significantly less pain and faster recovery.
• Antibiotics alone (n=3) averaged 31 days LOS; tube thoracostomy (n=11) averaged 13 days LOS; thoracotomy (n=5) averaged 16 days LOS.

Conclusions:

• Thoracoscopically aided pleural debridement (TAPD) is a viable and advantageous treatment for complicated pediatric empyema.
• TAPD is particularly beneficial for children with persistent loculated empyema or delayed lung expansion post-tube thoracostomy.
• This minimally invasive approach offers improved patient outcomes, including reduced pain and accelerated recovery.