Experience with video-assisted thoracoscopic surgery in the management of complicated pneumonia in children

Purpose: The aim of this study was to assess the impact of video assisted t horacoscopic surgery (VATS) in the management of empyema in children. Methods: This report involves cases of complicated pneumonia in children re quiring surgical intervention after failure of medical treatment with antib iotics, with or without drainage from November 1997 to October 1999. The im pact of VATS has been studied prospectively from October 1998 when VATS was introduced. The results have been compared with the previous year when sim ilar cases were dealt with open thoracotomy. These 2 groups of patients wit h VATS (V) or without VATS (O) were studied for their progress in hospital and the final outcome. Results: A total of 39 immunocompetent children with community-acquired pne umonia were studied. There were 17 cases in O and 22 in V. There were 2 con versions to open thoracotomy in V. Both of these cases required resection o f the lung parenchyma for severe necrosis and bronchopleural fistula. The m ean age in years was 5.3 (O) and 4.9 (V). Parameters that were significantl y less in V compared with O include timing of referral (O, 13.6 days; V, 5. 3 days), number of lung resections (O, 8; V, 2), blood transfusion (O, 14; V, 2), analgesia requirements (O, 7.8 days; V, 2.9 days), postoperative len gth of stay in hospital (O, 10.4 days; V, 4.6 days), time to become normoth ermic (O, 5.6 days; V, 1.7 days); and time to removal of chest drains (O, 6 .0 days; V, 2.7 days). Cosmesis is superior in cases of VATS compared with open thoracotomy. All the children recovered well on follow-up with resolut ion of symptoms and no recurrences. Conclusions: (1) VATS has ushered in a new era of hope for patients with co mplicated pneumonia. (2) Thoracotomy, lung resections, and the attending mo rbidity rate have decreased. (3) Patients are being referred earlier by the physicians because the management protocol is changing. Copyright (C) 2007 by W.B. Saunders Company.