Thoracoscopy in the management of empyema in children

Purpose: 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 31 patients (mean age 4.5 years). All failed conventional management with persistent fever, increasing oxygen requirement, recurrent effusion, and pleural consolidation, 10-mm trocars were used and complete decortication was accomplished. Results: All patients were afebrile by 72 h and discharged 5-10 days (mean 7.5 days) after surgery. 28 patients had clear chest x-rays by 1 month. The others had clear CXR at 3 months follow-up. Conclusions: Thoracoscopic decortication is a safe and effective means of treating pediatric empyemas. Clinical Implications: It should be condidered as a viable alternatives in pediatrics with empyema.