TIMING OF VIDEO-ASSISTED THORACOSCOPIC DEBRIDEMENT FOR PEDIATRIC EMPYEMA

Background: Video-assisted thoracoscopic debridement (VATD) is a new m ethod of managing pediatric empyema. The purpose of this retrospective study was to determine the relation between the timing of VATD and it s success in avoiding the need for open decortication. Study Design: T wenty-one children aged 3 to 16 years (mean, 8 years) with symptomatic , loculated, parapneumonic empyema were treated with VATD at two terti ary pediatric centers between 1994 and 1997. The preoperative duration of symptoms, hospitalization, and previous need for thoracostomy drai nage were compared between patients having VATD only and those who sub sequently required a thoracotomy and decortication. Statistical analys is used the Wald chi-square test or Fisher's exact test with p < 0.05 considered significant. Results: Video-assisted thoracoscopic debridem ent was successful in 15 patients (group 1) and unsuccessful in six pa tients (group 2), who required a thoracotomy and decortication. Group 1 had a shorter mean duration of preoperative symptoms (13 versus 27 d ays; p = 0.03), a shorter median duration of preoperative hospitalizat ion (6 versus 18 days; p = 0.04), and a lower incidence of previous th oracostomy drainage (4/15 versus 5/6; p = 0.05). Conclusions: The tech nique of VATD is most likely to be successful when used within one wee k of diagnosis of a loculated parapneumonic empyema. A prospective tri al comparing VATD with intrapleural fibrinolytic agents for the initia l treatment of pediatric empyema is needed. (J Am Cell Surg 1998;187:4 04-408. (C) 1998 by the American College of Surgeons).