The Role of Thoracoscopic Decortication in the Treatment of Childhood Empyema

Abstract

Pneumonia associated with parapneumonic effusion in children continues to be a common and, at times, a difficult problem to manage. While the majority of children can be treated with antibiotic therapy alone, once the effusion reaches the fibropurulent stage or later, the organizing stage treatment can become more complicated. In the past, once the empyema, these later stages, it was treated with antibiotics, prolonged chest tube drainage, and, if these failed, open thoracotomy for debridement. This was associated with long hospitalization and significant morbidity due to the delayed referral to a surgeon and to the surgical procedure itself. With the expanded use of endoscopic techniques, thoracoscopy has been increasingly used in the treatment of empyema and much earlier in the course of disease. The procedure can be performed quickly and efficiently through 2–5-mm incisions with minimal morbidity. Studies have shown that early thoracoscopic intervention can result in quicker recovery, a decreased length of hospital stay, and earlier return to normal activity, with minimal, if any, increased cost. These facts make this procedure ideal for the treatment of empyema in children.