Is there a place for thoracoscopic debridement in the treatment of empyemain children?

Background: Video-assisted thoracoscopic debridement has been shown to be a safe and efficient procedure for empyema in the adult patient. Its place i n the management of childhood empyema remains controversial. Methods: Over an 18-month period, 9 children were operated upon for pleural empyema. All children were initially treated with appropriate antibiotics and chest-tube drainage. Indication for surgery were persistent clinical sy mptoms and loculation of pleural fluid 5 to 7 days following initial treatm ent. In case of a duration of the illness of less than 14 days, an initial attempt was made to debride the pleural space by thoracoscopy. Results: Mean duration of the illness prior to surgery was 15 days (range: 10-23 days), and mean duration of preoperative conservative treatment 10 da ys (range: 5-20 days). In five of the nine patients thoracoscopy was perfor med. In all patients thoracoscopy failed to provide adequate clearance of t he diseased pleural space because of the advanced stage of the disease. The procedure was converted to a formal thoracotomy in four patients. the fift h patient continued to deteriorate and required formal thoracotomy and deco rtication seven days later. Conclusion: This limited experience suggests that, with the current managem ent and indications, video-assisted thoracoscopic surgery adds little benef it to the treatment of childhood empyema.