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Ratta A, Nascimben F, Angotti R, Todesco C, Carlini V, Fusi G, De Biagi L, Straziuso S, Italiano F, Domenichelli V, Messina M, Molinaro F. Pleural drainage vs video-assisted thoracoscopic debridement in children affected by pleural empyema. Pediatr Surg Int 2023; 39:287. [PMID: 37926703 PMCID: PMC10625948 DOI: 10.1007/s00383-023-05566-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Both thoracic drainage and video-assisted thoracic surgery (VATS) are available treatment for pleural empyema in pediatric patients. MATERIALS AND METHODS This retrospective multicenter study includes pediatric patients affected by pleural empyema treated from 2004 to 2021 at two Italian centers. Patients were divided in G1 (traditional approach) and G2 (VATS). Demographic and recovery data, laboratory tests, imaging, surgical findings, post-operative management and follow-up were analyzed. RESULTS 70 patients with a mean age of 4.8 years were included; 12 (17.1%) in G1 and 58 (82.9%) in G2. Median surgical time was 45 min in G1, 90 in G2 (p < 0.05). Mean duration of thoracic drainage was 7.3 days in G1, 6.2 in G2 (p > 0.05). Patients became afebrile after a mean of 6.4 days G1, 3.9 in G2 (p < 0.05). Mean duration of antibiotic therapy was 27.8 days in G1, 25 in G2 (p < 0.05). Mean duration of postoperative hospital stay was 16 days in G1, 12.1 in G2 (p < 0.05). There were 4 cases (33.3%) of postoperative complications in G1, 17 (29.3%) in G2 (p > 0.05). 2 (16.7%) patients of G1 needed a redosurgery with VATS, 1 (1.7%) in G2. CONCLUSIONS VATS is an effective and safe procedure in treatment of Pleural Empyema in children: it is associated to reduction of chest tube drainage, duration of fever, hospital stay, time of antibiotic therapy and recurrence rate.
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Affiliation(s)
- Alberto Ratta
- Pediatric Surgery Unit, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Francesca Nascimben
- Division of Paediatric Surgery, Department of Medical, Surgical and Neurological Sciences, Policlinico Le Scotte, University of Siena, Viale Bracci 14, 53100, Siena, Italy.
| | - Rossella Angotti
- Division of Paediatric Surgery, Department of Medical, Surgical and Neurological Sciences, Policlinico Le Scotte, University of Siena, Viale Bracci 14, 53100, Siena, Italy
| | - Camilla Todesco
- Division of Paediatric Surgery, Department of Medical, Surgical and Neurological Sciences, Policlinico Le Scotte, University of Siena, Viale Bracci 14, 53100, Siena, Italy
| | - Veronica Carlini
- Pediatric Surgery Unit, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Giulia Fusi
- Division of Paediatric Surgery, Department of Medical, Surgical and Neurological Sciences, Policlinico Le Scotte, University of Siena, Viale Bracci 14, 53100, Siena, Italy
| | - Lorenzo De Biagi
- Pediatric Surgery Unit, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Simona Straziuso
- Pediatric Surgery Unit, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | | | | | - Mario Messina
- Division of Paediatric Surgery, Department of Medical, Surgical and Neurological Sciences, Policlinico Le Scotte, University of Siena, Viale Bracci 14, 53100, Siena, Italy
| | - Francesco Molinaro
- Division of Paediatric Surgery, Department of Medical, Surgical and Neurological Sciences, Policlinico Le Scotte, University of Siena, Viale Bracci 14, 53100, Siena, Italy
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Manoharan A, Lodha R. Debate 1: Is the Management of Childhood Empyema Primarily Medical, or Surgical? Indian J Pediatr 2023; 90:910-914. [PMID: 37273131 DOI: 10.1007/s12098-023-04576-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/17/2023] [Indexed: 06/06/2023]
Abstract
This review aims to discuss the role of medical and surgical therapy in the management of pediatric empyema. There is considerable debate on the optimal treatment for the same. Early intervention is crucial as it allows rapid recovery of these patients. Antibiotics and adequate pleural drainage form the two pillars in the management of empyema. Chest tube drainage alone has significant failure rates due to its inability to clear loculated effusion. The two main modalities which target these loculations to augment drainage are video-assisted thoracoscopic surgery (VATS) and intrapleural fibrinolytic therapy. The latest evidence shows that both these interventions are equally effective. Children who present late are usually not candidates for intrapleural fibrinolytic therapy or VATS; for them, decortication remains the only option.
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Affiliation(s)
- Aravindhan Manoharan
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Jaiswal LS, Pandit N, Sah B, Prasad JN. Open pleural decortication for the late stage empyema thoracis in children: a retrospective observational study from a tertiary hospital of eastern Nepal. Trop Doct 2020; 50:203-209. [PMID: 32345149 DOI: 10.1177/0049475520921279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The management of late-stage empyema thoracis requires surgical intervention. We performed a retrospective descriptive analysis of open pleural decortication for late stage empyema thoracis in 55 children (age ≤ 15 years; median age = 6 years; age range = 1-15 years; 40 [72.7%] boys) over 42 months. The median time to thoracotomy from the onset of symptoms was 24 days, and the median duration of hospital stay before and after surgery was 15 and 4 days, respectively. Three (5.5%) patients had necrotising pneumonia, requiring debridement; 4 (7.3%) patients had superficial surgical site infection; 12 (21.8%) patients had perioperative pus culture positive for bacteria; and 3 (5.5%) patients had tubercular aetiology. There was no operative mortality. At median follow-up of 18 months, all patients are in good general health. Open pleural decortication leads to rapid resolution of symptoms and reduces hospital stay in paediatric late-stage empyema thoracis.
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Affiliation(s)
- Lokesh S Jaiswal
- Associate Professor, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Narendra Pandit
- Associate Professor, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Bijay Sah
- Assistant Professor Department of Surgery B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Jagat N Prasad
- Associate Professor, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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Pogorelić Z, Bjelanović D, Gudelj R, Jukić M, Petrić J, Furlan D. Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome. Thorac Cardiovasc Surg 2020; 69:475-480. [PMID: 32268399 DOI: 10.1055/s-0040-1708475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to observe outcomes of early decortication in a treatment of pleural empyema using video-assisted thoracoscopic surgery (VATS). METHODS The case records of 21 pediatric patients who underwent VATS for empyema between 2009 and 2019 were retrospectively reviewed. Patients were observed based on demographic, laboratory, and clinical data, as well as treatment outcomes. RESULTS Out of a total of 59 patients treated for pleural empyema, 21 (10 male and 11 female) children with a median age of 5 years (interquartile range [IQR] 2.8; 6.0) received VATS. The empyema was classified as stage I in 2 patients (9.5%), stage II in 4 patients (19%), and stage III in 15 patients (71.5%). Median surgical time was 60 minutes (IQR 50; 90). There were 2 (9.5%) postoperative complications and 1 recurrence (4.8%). Children treated in stages I and II showed significantly better postoperative results compared with the children treated in stage III. Length of hospital stay (8 vs. 10 days; p = 0.01), length of intensive care unit stay (1 vs. 5 days; p < 0.001), duration of chest tube drainage (4 vs. 6 days; p = 0.043), duration of postoperative fever (1.5 vs. 4 days; p = 0.001), and surgical time (40 vs. 70 minutes; p < 0.001) were significantly shorter in children operated in stages I and II than in stage III. CONCLUSION Early decortication using a VATS is a successful, effective, and easily performed surgical method in the treatment of pediatric pleural empyema, as well as a method that significantly improves recovery time and shortens the hospital stay.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | | | - Ružica Gudelj
- Faculty of Medicine, University of Split, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | - Jasna Petrić
- Department of Pediatrics, University Hospital of Split, Split, Croatia
| | - Dubravko Furlan
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
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