THORACOSCOPIC MANAGEMENT OF EMPYEMA IN CHILDREN

The appropriate management of empyema in children is controversial, Tr aditional surgical approaches have included thoracotomy and open drain age, decortication, and thoracoplasty, While generally effective, thes e procedures can be associated with considerable morbidity, We have so ught to assess the utility of video-assisted thoracoscopic adhesiolysi s and pleural debridement for the treatment of empyema in children, Ni ne children with postpneumonic empyema unsuccessfully managed with a s ingle attempt at closed tube thoracostomy underwent thoracoscopic drai nage during the past 2 years, The empyema was successfully treated wit h this technique in seven patients with no further interventions being required, Procedures performed early in the fibrinopurulent stage wer e technically easier, The average time before chest tube removal was 8 .5 days. An immunocompromised patient required a subsequent open decor tication and a patient with a coagulopathy required two subsequent ope n procedures for drainage of a recurrent hemothorax, We conclude from this experience that video-assisted thoracoscopic adhesiolysis and ple ural debridement can be successfully performed in children, Benefits i nclude good visualization of the entire thoracic cavity for more effec tive debridement and efficient drainage, and subjectively diminished p ostoperative pain and associated morbidity.