Early Thoracoscopy for the Management of Empyema in Children

Abstract

Background: Empyema is a significant cause of morbidity in children. Treatment is still a matter of controversy between surgical and non-surgical options. We reviewed our experience with the use of video-assisted thoracoscopy (VATS) in the treatment of empyema and proposed an algorithm.Patients and methods: We retrospectively reviewed all the pediatric patients recorded at our institution from January 2003 to December 2007 who were diagnosed with empyema and treated by surgery.Results: 23 children with empyema were treated with VATS during the review period. Mean age was 58.9 months and the duration of symptoms before admission was 6.1 days. All patients had a parapneumonic empyema treated by preoperative antibiotics (17/23 by parenteral antibiotics and 6/23 by oral antibiotics). Pre-operative imaging included chest X-ray in all cases and ultrasonography in all cases but one and computed tomography in 3 (13%). Our 23 patients underwent VATS within 5.3 days of hospitalisation, the most recent patients within 2 days. Chest tubes were removed after 2.7 days (range 2 to 4) resulting in a postoperative length of stay (LOS) of 10.3 days (range 6 to 28). Total LOS was 13.3 days (range 8 to 30). One patient required a conversion to thoracotomy. One patient required prolonged mechanical ventilation due to a severe myopathy during the post operative course, but there were no complications or deaths. Follow-up was available for all patients who all remained symptom-free and suffered no recurrence (clinical and radiological). Conclusion: Early thoracoscopy for empyema in children is safe and efficient in the short and mid-term outcome. We describe an algorithm based on our initial experience and review the literature for the management of empyema in children.