The surgical management of empyema consists of (1) aggressive therapy
with thoracotomy and decortication or (2) conservative treatment with
chest tube drainage and intravenous antibiotics. Recently, Kern and Ro
dgers introduced thoracoscopic debridement as an adjunct to the manage
ment of children with empyema, with promising results. Hence, the auth
ors report their experience with thoracoscopy in the management of ped
iatric patients with empyema. In the last years, 10 children have unde
rgone thoracoscopic debridement (TD) for empyema. The average age was
6.9 years (range, 2 to 16). Children underwent TD an average of 14 day
s (range, 8 to 16) after initial presentation and 4 days (range, 2 to
6) after admission to the authors' hospital. Indications for TD were p
ersistent requirement of supplemental oxygen and failure of conservati
ve medical management that consisted of antibiotics and tube thoracost
omy. Three children had positive pleural fluid cultures for Streptococ
cus pneumoniae. In all cases, preoperative ultrasound or chest compute
d tomography examination showed dense pleural fluid with septation. Du
ring surgery, TD allowed for lung expansion and precise chest tube pla
cement in all patients except one who required conversion to minithora
cotomy and decortication for persistent encasement with a thick pleura
l peel. There were no postoperative complications related to the proce
dure. After TD, all children had prompt clinical improvement. the pati
ents were weaned from supplemental oxygen by postoperative day 2, and
following early chest tube removal, nine children were discharged home
by postop erative day 7 (range, 3 to 10). One child required further
hospitalization for underlying renal failure. In the authors' hands, T
D was effective in producing prompt clinical improvement in children w
ith empyema. Therefore it should be considered an alternative to prolo
nged tube thoracostomy or thoracotomy in children with recalcitrant em
pyema. Copyright (C) 1995 by W.B. Saunders Company