BAPS papersEfficacy of video-assisted thoracoscopic surgery in managing childhood empyema: a large single-centre study
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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Cited by (42)
Operative versus percutaneous drainage with fibrinolysis for complicated pediatric pleural effusions: A nationwide analysis
2023, Journal of Pediatric SurgeryFactors Associated With Successful Video-Assisted Thoracoscopic Surgery for Traumatic Hemothorax in Children: A Cross-Sectional Study
2022, Journal of Surgical ResearchCitation Excerpt :While observation alone is safe for some children with small volume hemothorax,6 others will require drainage via tube thoracostomy or operative evacuation. Historically, surgical drainage was approached via thoracotomy; however, video-assisted thoracoscopic surgery (VATS) has emerged as a viable, minimally invasive modality for the treatment of a variety of thoracic pathologies in children.7-9 At this time, most studies involving children with traumatic hemothorax are confined to broader studies of pediatric thoracic trauma.
Consensus Document on Community-Acquired Pneumonia in Children. SENP-SEPAR-SEIP
2020, Archivos de BronconeumologiaThoracoscopic debridement for empyema thoracis
2020, Journal of Pediatric SurgeryCitation Excerpt :As discussed earlier, there have been changes in the incidence and severity of empyema since these RCTs finished recruiting. In our original series (2004–2008) only 8 children underwent upfront thoracotomy for PN/BPF [9]. The figure was 20 in the current series (18.9% versus 7.0%).
Thoracoscopy in stage 3 empyema thoracis in children – A safe and feasible alternative to thoracotomy
2020, Journal of Pediatric SurgeryCitation Excerpt :Prospective studies with large numbers are required to further assess the role of fibrinolytics in organized empyema. After Kern et al. [12] reported the first use of VATS in the management of children with empyema, several studies have emphasized the role of early VATS in the treatment of empyema with a shorter hospital stay, less morbidity and successful outcome [13–16]. In empyema present for more than 3 weeks, decortication becomes challenging due to dense adhesions and thick pleural peel [17,18].
Evolution of practice in the management of parapneumonic effusion and empyema in children
2018, Journal of Pediatric Surgery
Presented at the 55th Annual Congress of the British Association of Paediatric Surgeons, Salamanca, Spain, July 2-5, 2008.