THORACOSCOPY FOR EMPYEMA IN CHILDREN

Methods: During a 19-month period, seven children with empyema underwe nt thoracoscopy. The average age was 7.5 years (range, 3 to 15 years) and the duration of illness before surgery 16.5 days (range, 7 to 42 d ays). All patients received preoperative antibiotics, underwent ultras ound or CT scan and thoracentesis. Two patients had preoperative inter costal tube drainage. Indications for operations were lack of response to antibiotics of loculation of pleural fluid on imaging. All procedu res were performed under general anesthesia with a single lumen tube. Results: Thoracoscopy allowed for good access and complete clearance i n two patients. In the remaining patients, thoracoscopy failed to clea r the disease because of difficulty with access, instrumentation, and clearance of thick debris. These patients underwent thoracotomy with t wo requiring decortication. Conclusions: This experience suggests that even in the early stage of empyema formation, thoracoscopy is not as effective as thoracotomy. Larger experience and studies are required t o define the place of thoracoscopy in the management of childhood empy ema. Copyright (C) 1998 by W.B. Saunders Company.