Skip to main content
SpringerLink
Log in

Timely thoracoscopic decortication promotes the recovery of paediatric parapneumonic empyema

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Introduction

Parapneumonic empyema is one of the most commonly encountered yet difficult to manage paediatric thoracic conditions. Conservative treatment with chest tube drainage and fibrinolytic agents had been proposed but operative decortication remains the gold standard for refractory cases. Thoracoscopic decortication has been advocated in recent years due to its superiority in terms of post-operative pain, cosmesis and other long-term results. However, few studies investigated the effect of timing on peri-operative outcomes. This study aims to explore the benefits of early decortication.

Methods

Retrospective study of all patients who underwent thoracoscopic decortication between 1999 and 2013 at a tertiary referral centre was performed. Data were extracted from respective medical records. Patients’ demographics, peri-operative outcomes, length of hospitalization and post-operative complications were analysed.

Results

A total of 28 patients were identified, 12 males and 16 females. Average age of patients was 4.5 years (range 12 months–14 years). Right-sided empyema was involved in 14 of the patients. Patients who underwent operation within 2 weeks from symptom onset (n = 16) showed significant shorter post-operative hospital stay (mean 9.5 vs 20.4 days, p = 0.003) and total hospitalization duration (mean 19.3 vs 38.8 days, p < 0.001). Correlation study demonstrated a strong relation between delay in operation and prolonged hospitalization (r = 0.63, p = 0.001). The peri-operative and post-operative outcomes were similar. No major post-operative complication was encountered except one patient who required a second decortication for residual empyema.

Conclusion

Thoracoscopic decortication is a safe and feasible procedure for parapneumonic empyema. Timely surgery is recommended as it promotes early recovery and shorter hospitalization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H (2008) Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 86:408–416

    Article  PubMed Central  PubMed  Google Scholar 

  2. Chonmaitree T, Powell KR (1983) Parapneumonic pleural effusion and empyema in children. Review of a 19-year experience, 1962–1980. Clin Pediatr (Phila) 22:414–419

    Article  CAS  Google Scholar 

  3. Byington CL, Spencer LY, Johnson TA, Pavia AT, Allen D, Mason EO et al (2002) An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis 34:434–440

    Article  PubMed  Google Scholar 

  4. Lahti E, Peltola V, Virkki R, Alanen M, Ruuskanen O (2007) Development of parapneumonic empyema in children. Acta Paediatr 96:1686–1692

    Article  PubMed  Google Scholar 

  5. Grijalva CG, Zhu Y, Nuorti JP, Griffin MR (2011) Emergence of parapneumonic empyema in the USA. Thorax 66:663–668

    Article  PubMed  Google Scholar 

  6. Byington CL, Hulten KG, Ampofo K, Sheng X, Pavia AT, Blaschke AJ et al (2010) Molecular epidemiology of pediatric pneumococcal empyema from 2001 to 2007 in Utah. J Clin Microbiol 48:520–525

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D et al (2005) BTS guidelines for the management of pleural infection in children. Thorax 60(Suppl 1):i1–i21

    Article  PubMed Central  PubMed  Google Scholar 

  8. Hernandez-Bou S, Garcia-Garcia JJ, Esteva C, Gene A, Luaces C, Munoz Almagro C (2009) Pediatric parapneumonic pleural effusion: epidemiology, clinical characteristics, and microbiological diagnosis. Pediatr Pulmonol 44:1192–1200

    Article  PubMed  Google Scholar 

  9. Byington CL, Korgenski K, Daly J, Ampofo K, Pavia A, Mason EO (2006) Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr Infect Dis J 25:250–254

    Article  PubMed  Google Scholar 

  10. Islam S, Calkins CM, Goldin AB, Chen C, Downard CD, Huang EY et al (2012) The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg 47:2101–2110

    Article  PubMed  Google Scholar 

  11. Paraskakis E, Vergadi E, Chatzimichael A, Bouros D (2012) Current evidence for the management of paediatric parapneumonic effusions. Curr Med Res Opin 28:1179–1192

    Article  CAS  PubMed  Google Scholar 

  12. St Peter SD, Tsao K, Spilde TL, Keckler SJ, Harrison C, Jackson MA et al (2009) Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg 44:106–111 (discussion 111)

    Article  PubMed Central  PubMed  Google Scholar 

  13. Shahin Y, Duffy J, Beggs D, Black E, Majewski A (2010) Surgical management of primary empyema of the pleural cavity: outcome of 81 patients. Interact CardioVasc Thorac Surg 10:565–567

    Article  PubMed  Google Scholar 

  14. Bilgin M, Akcali Y, Oguzkaya F (2006) Benefits of early aggressive management of empyema thoracis. ANZ J Surg 76:120–122

    Article  PubMed  Google Scholar 

  15. Shivachev K, Brankov O, Drebov R, Panov M, Gavrilova N, Kisimova V et al (2007) contemporary treatment of parapneumonic pleural complication in children: the role of video—assisted thoracoscopic surgery (VATS). Khirurgiia (Sofiia) 3:14–18

    Google Scholar 

  16. Bishay M, Short M, Shah K, Nagraj S, Arul S, Parikh D et al (2009) Efficacy of video-assisted thoracoscopic surgery in managing childhood empyema: a large single-centre study. J Pediatr Surg 44:337–342

    Article  PubMed  Google Scholar 

  17. Luh SP, Chou MC, Wang LS, Chen JY, Tsai TP (2005) Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: outcome of 234 patients. Chest 127:1427–1432

    Article  PubMed  Google Scholar 

  18. Yamaguchi M, Takeo S, Suemitsu R, Matsuzawa H, Okazaki H (2009) Video-assisted thoracic surgery for fibropurulent thoracic empyema: a bridge to open thoracic surgery. Ann Thorac Cardiovasc Surg 15:368–372

    PubMed  Google Scholar 

  19. Klena JW, Cameron BH, Langer JC, Winthrop AL, Perez CR (1998) Timing of video-assisted thoracoscopic debridement for pediatric empyema. J Am Coll Surg 187:404–408

    Article  CAS  PubMed  Google Scholar 

  20. Khalil BA, Corbett PA, Jones MO, Baillie CT, Southern K, Losty PD et al (2007) Less is best? The impact of urokinase as the first line management of empyema thoracis. Pediatr Surg Int 23:129–133

    Article  CAS  PubMed  Google Scholar 

  21. Thomson AH, Hull J, Kumar MR, Wallis C, Balfour Lynn IM (2002) Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax 57:343–347

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Goldin AB, Parimi C, LaRiviere C, Garrison MM, Larison CL, Sawin RS (2012) Outcomes associated with type of intervention and timing in complex pediatric empyema. Am J Surg 203:665–673

    Article  PubMed  Google Scholar 

  23. Barbato A, Panizzolo C, Monciotti C, Marcucci F, Stefanutti G, Gamba PG (2003) Use of urokinase in childhood pleural empyema. Pediatr Pulmonol 35:50–55

    Article  CAS  PubMed  Google Scholar 

  24. Blom D, van Aalderen WM, Alders JM, Hoekstra MO (2000) Life-threatening hemothorax in a child following intrapleural administration of urokinase. Pediatr Pulmonol 30:493

    Article  CAS  PubMed  Google Scholar 

  25. Balci AE, Eren S, Ulku R, Eren MN (2002) Management of multiloculated empyema thoracis in children: thoracotomy versus fibrinolytic treatment. Eur J Cardiothorac Surg 22:595–598

    Article  PubMed  Google Scholar 

  26. Chung JH, Lee SH, Kim KT, Jung JS, Son HS, Sun K (2014) Optimal timing of thoracoscopic drainage and decortication for empyema. Ann Thorac Surg 97:224–229

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam Road, Hong Kong, China

    C. T. Lau, C. H. Fung, K. K. Y. Wong & P. Tam

Authors
  1. C. T. Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. H. Fung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. K. Y. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Tam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. T. Lau.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lau, C.T., Fung, C.H., Wong, K.K.Y. et al. Timely thoracoscopic decortication promotes the recovery of paediatric parapneumonic empyema. Pediatr Surg Int 31, 665–670 (2015). https://doi.org/10.1007/s00383-015-3723-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-015-3723-y

Keywords

Search

Navigation