Early video-assisted thoracic surgery in the management of empyema

Objective. The appropriate timing, as well as the type of intervention, for the treatment of empyema in children is controversial. The advent of video -assisted thoracic surgery (VATS) has changed the way we treat these childr en. Therefore, we reviewed our experience with the early use of VATS in the treatment of empyema and formulated a treatment algorithm. Methods. We retrospectively reviewed medical records of all patients underg oing VATS for empyema at Arkansas Children's Hospital from December 1994 to February 1997. All patients were treated by the pediatric surgical service and had the diagnosis of empyema confirmed at surgery. Results are reporte d as means, unless otherwise noted. Results. Twenty-five children with empyema were treated with VATS during th e review period. Their age was 48.3 months, and the duration of symptoms wa s 7.4 days. All the patients had parapneumonic empyemas and had received pr eoperative antibiotics for 10.1 days. Preoperative imaging included chest r adiography in 25 (100%), ultrasonography in 20 (80%), and computed tomograp hy in 10 (40%). All patients with documented loculated parapneumonic fluid collections underwent VATS within a mean of 2 days of hospitalization. Ches t tubes were removed in 3.2 days, resulting in a postoperative length of st ay of 4.9 days. Total length of stay was 7.3 days. One patient required con version to minithoracotomy and required a transfusion. There were no other complications or deaths. Follow-up was available for 22 (88%) children, and there was resolution of symptoms in all children with no recurrences. Conclusions. Earlier intervention with VATS in the treatment of empyema in children is safe and may reduce hospital charges by shortening hospital sta y. A treatment algorithm based on early use of VATS is also described.