Thoracoscopic decortication as first-line therapy for pediatric parapneumonic empyema - A case series

Study objectives: Previous articles have promoted the early use of thoracot omy and decortication for refractory empyema, This study examines thoracosc opy and decortication at the time of initial chest tube placement in pediat ric patients with parapneumonic emp ema. Design: We reviewed the medical records of 16 consecutive patients who were children with parapneumonic empyema. Results: Thirteen children (group 1) underwent thoracoscopic decortication and tube thoracostomy as their initial operative procedures; 3 children (gr oup 2) had tube thoracostomy alone. In both groups, chest tubes were remove d prior to their discharge to home, The mean (+/- SD) operative time for th oracoscopy was 81 +/- 19 min with no complications. On average, chest tubes were removed by postoperative day 4. The mean time to discharge was 8.3 da ys. Two children eventually required lobectomy, The mean operative time for chest tube placement alone was 21 +/- 3 min. Children required chest tube drainage for an average of 12.3 days, The mean time to discharge was 16.6 d ays. Two patients required a total of five additional operative procedures, including two additional chest tube placements, two open decortications, a nd one lobectomy. Conclusions: Thoracoscopic decortication is effective in the early treatmen t of pediatric parapneumonic emp) ema. It facilitates visualization, evacua tion, and mechanical decortication of the pleural space with no additional morbidity and may lead to reduced time for chest tube drainage, shorter hos pitalization, and more rapid clinical recovery.