Thoracoscopy in the management of thoracic empyema in children younger than 4 years

Video-assisted thoracoscopic surgery is widely performed in adults but ther e are few publications concerning the paediatric population. The objective is to effect optimal adhesiolysis of post-pneumonic loculated empyema with lower morbidity. Patients and methods. - Over a 4-year period we used thoracoscopic debridem ent in five children younger than 4 years of age with loculated thoracic em pyema, Ail patients failed initial treatment including antibiotics and ches t tube drainage. Early sonographic evaluation of the empyema organization g uided the most appropriate moment for the intervention. The average duratio n of tube drainage after thoracoscopy was 4 days (range: 1 to 7 days). Results. - All patients made an uneventful postoperative recovery. At a fol low-up visit I month after discharge, the children were clinically asymptom atic; however, some degree of pleural thickening was still visible on chest X-rays. Conclusion. - In skilled hands, thoracoscopy is a safe procedure for post-p neumonic empyema in young children, providing a rapid clinical and radiolog ical recovery with a good cosmetic result. (C) 2001 Editions scientifiques et medicales Elsevier SAS.