Video-assisted thoracoscopic surgery for children with stage II empyema

Children with stage II empyema often fail traditional medical management, f requently succumbing to the effective albeit morbid clutches of thoracotomy . Video-assisted thoracoscopic surgery (VATS) has been recently introduced as a viable and potentially less morbid alternative to open thoracotomy, We review our VATS experience in children with empyema, assessing surgical ou tcome. Between August 1996 and March 1999, 13 patients at our institution w ith stage II empyema that did not respond to conventional medical managemen t underwent a modified VATS with decortication, Data from retrospective cha rt review reflects intraoperative findings and postoperative course, includ ing average time to defervescence, removal of thoracostomy tube, and hospit al discharge. VATS was completed in all 13 patients. All intraoperative cul tures of pleural fluid and fibrinopurulent debris obtained at VATS showed n o growth, The average time to defervescence was 2.2 days (range, 0-4 days) and to removal of thoracostomy tube 3.6 days (range, 2-5 days). Average tot al chest tube days in patients with pre-VATS thoracostomy (n = 6) was 14.5 days (range, 8-37 days) versus 3.1 days (range, 2-5 days) in patients (n = 7) who underwent primary VATS (t test, p < 0.05). The average time to surgi cal discharge after VATS was 5.8 days (range, 3 to 19 days). All patients w ere well on follow-up clinic visits without delayed complications. VATS can be performed safely and effectively in children with stage II empyema, thu s avoiding the morbidity of open thoracotomy and decortication. Importantly , early application of VATS significantly relieves patients of unnecessary days of thoracostomy drainage.