Favorable outcome of parapneumonic empyema in children managed by primary video-assisted thoracoscopic debridement

Background and Purpose: The appropriate type of intervention for the treatment of empyema in children remains controversial. This study analyzed whether video-assisted thoracoscopic debridement (VATD) as first-line treatment is effective in the management of pediatric parapneumonic empyema. Methods: We retrospectively reviewed the medical and microbiological records of pediatric patients with parapneumonic empyema diagnosed at a medical center from January 1995 to December 2002. The 55 patients included in this study were initially treated with either tube thoracostomy drainage (TTD group [n = 37]) or video-assisted thoracoscopic debridement (VATD group [n = 18]). Results: A comparative analysis found no significant difference in patient characteristics between these 2 groups. Patients in the VATD group had a significantly shorter duration of fever (18.9±1.7 vs 26.9±1.3 days), chest tube placement (5.3±0.7 vs 15.2±2.0 days), antibiotic therapy after the procedure (12.2±1.0 vs 26.3±2.8 days), and hospital stay (21.5±2.1 vs 33.2±2.8 days). No additional procedures were required in the VATD group, whereas 65% (24/37) of patients in the TTD group underwent salvage VATD. Conclusion: Primary management using video-assisted thoracoscopic decortication was more effective and reduced the duration of illness in pediatric patients with parapneumonic empyema.