BAPS papers
Efficacy of video-assisted thoracoscopic surgery in managing childhood empyema: a large single-centre study

https://doi.org/10.1016/j.jpedsurg.2008.10.083Get rights and content

Abstract

Background/Purpose

A randomised controlled trial evaluating the role of video-assisted thoracoscopic surgery (VATS) in childhood empyema reported a failure rate of 16.6%. Our aim is to determine the outcome of VATS in a large series of children managed by 3 paediatric surgeons experienced in endoscopic surgery.

Method

A retrospective study of all children with empyema admitted under the care of the 3 surgeons between February 2004 and February 2008 was undertaken. Recorded details included demographic data, mode of presentation, preoperative investigations, operative details, antibiotic usage, microbiological data, postoperative course, follow-up data and complications.

Results

114 children (69 boys, 45 girls) had VATS for empyema. Their median age was 5 (0.2-15) years. The pleural cavity was drained for a median of 4 (2-13) days. Median postoperative hospital stay was 7 (4-36) days. Median follow-up was 8 (1-24) months. There were 8 (7%) treatment failures: 5 conversions to thoracotomy and 3 recurrent empyemas. There were 7 complications (6%): air leak (n = 6) and lung injury (n = 1). 104 (91%) children had full resolution of symptoms. There were no deaths.

Conclusion

Video-assisted thoracoscopic surgery has a better outcome in childhood empyema than reported in a recent randomised trial and it has an important role in the management of this condition.

Section snippets

Patients and methods

A retrospective study of all children with empyema admitted under the care of 3 paediatric surgeons at Birmingham Children's Hospital between February 2004 and February 2008 was undertaken. The following information was retrieved from the patient records: demographic data, mode of presentation, preoperative investigations, operative details, conversion to open, antibiotic usage, microbiological data, recurrence of empyema, postoperative course, duration of chest drainage, hospital stay and

Results

Between February 2004 and February 2008, 122 children were admitted under the care of the 3 surgeons with empyema. Eight children underwent primary thoracotomy for complex empyema associated with spontaneous bronchopleural fistula. 114 children (69 boys, 45 girls) underwent VATS. Their median age was 5 (0.2-15) years. The median time interval from onset of symptoms to presentation was 6 (0-28) days. 102 (89%) of the patients were referred from secondary care centres. The median time interval

Discussion

The choice of first-line treatment of childhood empyema remains controversial, with no clear consensus on whether nonoperative (chest drain with or without intrapleural fibrinolytic therapy) or operative management (VATS or thoracotomy) is more appropriate. The simplest form of nonoperative treatment is drainage of the pleural cavity. This form of treatment is not advocated by the British Thoracic Society on the basis that it is associated with prolonged duration of illness and hospital stay [7]

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    Presented at the 55th Annual Congress of the British Association of Paediatric Surgeons, Salamanca, Spain, July 2-5, 2008.

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