Thoracoscopic management of empyema thoracis in pediatrics; effectiveness and early outcomes

Abstract

Background: Empyema is one of the most common diseases in children, with an excellent prognosis upon appropriate treatment in the early course of the disease. Multiple studies demonstrated that compared to thoracocentesis or chest tube alone, the use of VATS significantly decreases the length of hospital stay. Performing VATS as the primary intervention early in the hospital course can decrease the length of hospital stay, as shown in different studies. This study compares the efficacy of video-assisted thoracoscopic surgery (VATS) in managing empyema in pediatrics compared to classic drainage using an intercostal tube alone.Methods: The study included 61 pediatric patients with empyema thoracis, who were divided into two groups: A (chest tube only) and B (thoracoscopic drainage). Patients were discharged once their clinical condition improved, after which a three-month follow-up was completed.Results: Group A included 37 patients (17 males and 20 females), while Group B comprised 24 patients (11 males and 13 females). Fever was the most frequently presenting symptom in both groups, followed by cough and dyspnea. The hospital stay was significantly shorter in Group B, with a significant difference in the radiological improvement upon early follow-up after one week. No difference was observed in late follow-up after three months.Conclusions: Thoracoscopic drainage of empyema thoracis in the pediatric population has several advantages over conventional chest tube drainage, such as shorter hospital stays and earlier improvement. We recommend the implementation of thoracoscopic drainage of empyema whenever feasible for better outcomes.