Timely thoracoscopic decortication promotes the recovery of paediatric parapneumonic empyema
AIM To reveal the role of Video Assisted Thoracoscopic Surgery (VATS) in the treatment of different stages of pleural empyema in children. CLINICAL MATERIAL Between 2004 and 2006, 87 children aged from 11 months to 18 years were treated at the Department of Thoracic pediatric surgery for parapneumonic pleural complications (pleural empyema). The children were admitted in a period from 5 to 30 days (mean 11.9) after the initial pulmonary symptoms. Of them 41 children were treated by means of VATS. The indications for this approach were based on clinical course, radiological features, chest ultrasound image and fluid examination. RESULTS Primary thoracostomy underwent 22 children (53.6%). VATS was applied in a period of 3 to 12 days after the initial procedure. The indications for VATS includes: a) multiloculated pleural effusion, b) encapsulated empyema and c) failed tube drainage. According to the local finding VATS was performed for evacuation of the flocculated exudate and debridement of fibrinous adhesions in 25 children (61 %). In 16 children (39 %) VATS comprised debridement and decortication. The mean operative time amounts 74.1 min (from 50 to 125). There were 4 conversions to open thoracotomy due to evaluation of necrotic lung parenchyma. Pleural drainage lasts from 2 to 12 days (mean 4.8). The postoperative hospital stay takes from 5 to 24 days (mean 10.2). CONCLUSION VATS is an appropriate and effective method for treatment of children with complicated parapneumonic effusion in the second (fibrino-purulent) stage as well by some indication in the third (organization) stage.