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Pediatric Surgery International
Published in: Pediatric Surgery International 1/2023

Open Access 01-12-2023 | Pleural Empyema | Original Article

Pleural drainage vs video-assisted thoracoscopic debridement in children affected by pleural empyema

Authors: Alberto Ratta, Francesca Nascimben, Rossella Angotti, Camilla Todesco, Veronica Carlini, Giulia Fusi, Lorenzo De Biagi, Simona Straziuso, Francesco Italiano, Vincenzo Domenichelli, Mario Messina, Francesco Molinaro

Published in: Pediatric Surgery International | Issue 1/2023

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Abstract

Background

Both thoracic drainage and video-assisted thoracic surgery (VATS) are available treatment for pleural empyema in pediatric patients.

Materials and methods

This retrospective multicenter study includes pediatric patients affected by pleural empyema treated from 2004 to 2021 at two Italian centers. Patients were divided in G1 (traditional approach) and G2 (VATS). Demographic and recovery data, laboratory tests, imaging, surgical findings, post-operative management and follow-up were analyzed.

Results

70 patients with a mean age of 4.8 years were included; 12 (17.1%) in G1 and 58 (82.9%) in G2. Median surgical time was 45 min in G1, 90 in G2 (p < 0.05). Mean duration of thoracic drainage was 7.3 days in G1, 6.2 in G2 (p > 0.05). Patients became afebrile after a mean of 6.4 days G1, 3.9 in G2 (p < 0.05). Mean duration of antibiotic therapy was 27.8 days in G1, 25 in G2 (p < 0.05). Mean duration of postoperative hospital stay was 16 days in G1, 12.1 in G2 (p < 0.05). There were 4 cases (33.3%) of postoperative complications in G1, 17 (29.3%) in G2 (p > 0.05). 2 (16.7%) patients of G1 needed a redosurgery with VATS, 1 (1.7%) in G2.

Conclusions

VATS is an effective and safe procedure in treatment of Pleural Empyema in children: it is associated to reduction of chest tube drainage, duration of fever, hospital stay, time of antibiotic therapy and recurrence rate.
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Literature
1.
Redden MD, Chin TY, van Driel ML (2017) Surgical versus non-surgical management for pleural empyema. Cochrane Database Syst Rev 3(3):010651
2.
Roxburgh CSD, Youngson GG, Townend JA, Turner SW (2008) Trends in pneumonia and empyema in Scottish children in the past 25 years. Arch Dis Child 93:316–318CrossRefPubMed
3.
Mandal AK (1997) Post-traumatic empyema tho- racis: a 24 year experience at a major trauma centre. J Trauma 43:764–761CrossRefPubMed
4.
Parelkar SV, Patil SH, Sanghvi BV, Gupta RK, Mhaskar SS, Shah RS, Tiwari P, Pawar AA (2017) Video-Assisted Thoracoscopic Surgery for Pediatric empyema by two-port technique: a single-center experience with 167 consecutive cases. J Indian Assoc Pediatr Surg 22:150CrossRefPubMedPubMedCentral
5.
Proesmans M, De Boeck K (2009) Clinical practice: Treatment of childhood empyema Eur. J Pediatr 168:639–645
6.
Iarussi T, Cipollone G, Quitadamo S, Altobelli S, Sacco R (2003) Il trattamento dell’empiema pleurico per VATS Ann. Ital Chir 74:9–12
7.
Cerchia E, Ferrero L, Molinaro F, Donato L, Messina M, Becmeur F (2016) Pediatric thoracoscopy and bronchial blockers: the continued search for the ideal one-lung ventilation. J Laparoendosc Adv Surg Tech A 26(2):153–156CrossRefPubMed
8.
Grisaru-Soen G, Eisenstadt M, Paret G, Schwartz D, Keller N, Nagar H, Reif S (2013) Pediatric parapneumonic empyema: risk factors, clinical characteristics, microbiology, and management. Pediatr Emerg Care 29(4):425–429CrossRefPubMed
9.
Knudtson J, Grewal H (2004) Pediatric empyema–an algorithm for early thoracoscopic intervention. JSLS J Soc Laparoendosc Surg 8(1):31–34
10.
Barglik R, Grabowski A, Korlacki W, Pasierbek M, Modrzyk A (2021) Pleural empyema in children - benefits of primary thoracoscopic treatment. Wideochir Inne Tech Maloinwazyjne 16(1):264–272PubMed
11.
Molinaro F et al., Pediatric Thoracic Surgery. Thoracic Empyema, Italia, Springer, 2013
12.
Bender MT, Ward AN, Iocono JA, Saha SP (2015) Current surgical management of empyema thoracis in children: a single-center experience. Am Surg 81(09):849–853CrossRefPubMed
13.
Velaiutham S, Pathmanathan S, Whitehead B, Kumar R (2010) Videoassisted thoracoscopic surgeryof childhood empyema: early referral improves outcome. Pediatr Surg Int 26(10):1031–1035CrossRefPubMed
14.
Aziz A, Healey JM, Qureshi F, Kane TD, Kurland G, Green M, Hackam DJ (2008) Comparative analysis of chest tube thoracostomy and video-assisted thoracoscopic surgery in empyema and parapneumonic effusion associated with pneumonia in children. Surg Infect 9(3):317–323CrossRef
15.
16.
Scarci M, Zahid I, Billé A, Routledge T (2011) Is video-assisted thoracoscopic surgery the best treatment for paediatric pleural empyema? Interact Cardiovasc Thorac Surg 13(1):70–76CrossRefPubMed
17.
Cohen G, Hjortdal V, Ricci M, Jaffe A, Wallis C, Dinwiddie R, Elliott MJ, De Leval MR (2003) Primary thoracoscopic treatment of empyema in children. J Thorac Cardiovasc Surg 125:79–83CrossRefPubMed
18.
Kurt BA, Winterhalter KM, Connors RH, Betz BW, Winters JW (2006) Therapy of parapneumonic effusions in children: video-assisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics 118:e547–e553CrossRefPubMed
19.
Li ST, Gates RL (2008) Primary operative management for pediatric empyema: decreases in hospital length of stay and charges in a national sample. Arch Pediatr Adolesc Med 162:44–48CrossRefPubMed
20.
Avansino JR, Goldman B, Sawin RS, Flum DR (2005) Primary operative versus nonoperative therapy for pediatric empyema: a metanalysis. Pediatrics 115:1652–1659CrossRefPubMed
Metadata
Title
Pleural drainage vs video-assisted thoracoscopic debridement in children affected by pleural empyema
Authors
Alberto Ratta
Francesca Nascimben
Rossella Angotti
Camilla Todesco
Veronica Carlini
Giulia Fusi
Lorenzo De Biagi
Simona Straziuso
Francesco Italiano
Vincenzo Domenichelli
Mario Messina
Francesco Molinaro
Publication date
01-12-2023
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 1/2023
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-023-05566-z

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