THORACOSCOPY IN THE MANAGEMENT OF PEDIATRIC EMPYEMA

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