Skip to main content
Log in

Debate 2: Is the Management of Childhood Empyema Primarily Medical, or Surgical?

  • Review Article
  • Published:
Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The management of empyema thoracis has changed in the past 1–2 decades with the advent of video-assisted thoracoscopy (VATS), the surgeon’s weapon and fibrinolytic agents, the physician’s weapon. Inappropriate use of either and inability to accept their failure in some cases cause prolonged morbidity in an unsuspecting patient. VATS has been shown to be very effective in stage 2 empyema and is associated with early amelioration of symptoms and early discharge from hospital. Open thoracotomy still plays an important role in the management of delayed and complicated cases of empyema and has always produced good results. Some complications seen by surgeons are related to previous interventions and delayed referral. Lung status plays an important role in post operative recovery. In patients requiring intervention, both medical and surgical options should be considered without bias early in the management and discussed with care-givers to give best outcome.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Derderian SC, Meier M, Partrick DA, et al. Pediatric empyemas-has the pendulum swung too far? J Pediatr Surg. 2020;55:2356–61.

    Article  PubMed  Google Scholar 

  2. Shen KR, Bribriesco A, Crabtree T, et al. The American Association for thoracic surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 2017;153:e129–46.

    Article  PubMed  Google Scholar 

  3. Redden MD, Chin TY, van Driel ML. Surgical versus non-surgical management for pleural empyema. Cochrane Database Syst Rev. 2017;3:CD010651.

  4. Heidecker JT, Sahn SA. Intrapleural Fibrinolytics. In Ferguson MK, editor. Difficult decisions in thoracic surgery. Springer; London: 2007. p. 433–41.

  5. Peters RT, Parikh DH, Singh M. Thoracoscopic debridement for empyema thoracis. J Pediatr Surg. 2020;55:2187–90.

    Article  PubMed  Google Scholar 

  6. Lamas-Pinheiro R, Henriques-Coelho T, Fernandes S, et al. Thoracoscopy in the management of pediatric empyemas. Rev Port Pneumol. 2016;22:157–62.

    CAS  PubMed  Google Scholar 

  7. Pereira RR, Alvim CG, Andrade CR, Ibiapina CC. Parapneumonic pleural effusion: early versus late thoracoscopy. J Bras Pneumol. 2017;43:344–50.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Santanakrishnan R, Murali GS, Javaregowda D, Shankar G, Babu N, Jadhav V. Thoracoscopy in stage 3 empyema thoracis in children – a safe and feasible alternative to thoracotomy. J Pediatr Surg. 2020;55:756–60.

    Article  PubMed  Google Scholar 

  9. Menon P, Kanojia RP, Rao K. Empyema thoracis: Surgical management in children. J Indian Assoc Pediatr Surg. 2009;14:85–93.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Menon P, Rao KLN, Singh M, et al. Surgical management and outcome analysis of stage III pediatric empyema thoracis. J Indian Assoc Pediatr Surg. 2010;15:9–14.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Avansino JR, Goldman B, Sawin RS, Flum DR. Primary operative versus non operative therapy for pediatric empyema: a meta-analysis. Pediatrics. 2005;115:1652–9.

    Article  PubMed  Google Scholar 

  12. Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Resp Crit Car Med. 2006;174:221–7.

    Article  Google Scholar 

  13. Kurt BA, Winterhalter KM, Connors RH, Betz BW, Winters JW. Therapy of parapneumonic effusions in children: video assisted thoracoscopic surgery vs conventional thoracostomy drainage. Pediatrics. 2006;118:547–53.

    Article  Google Scholar 

  14. Peter SD, Tsao K, Harrison C, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009;44:106–11.

    Article  Google Scholar 

  15. Marhuenda C, Barcelo C, Fuentes I, et al. Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial. Pediatrics. 2014;134:1301–7.

    Article  Google Scholar 

  16. Shankar G, Sahadev R, Santhanakrishnan R. Pediatric empyema thoracis management: should the consensus be different for the developing countries? J Pediatr Surg. 2020;55:513–7.

    Article  PubMed  Google Scholar 

  17. Bender MT, Ward AN, Iocono JA, Saha SP. Current surgical management of empyema thoracis in children: a single-center experience. Am Surg. 2015;81:849–53.

    Article  PubMed  Google Scholar 

  18. Garvia V, Paul M. Empyema. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. PMID: 29083780. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459237/.

  19. Balci AE, Eren S, Ulku R, Eren MN. Management of multiloculated empyema thoracis in children: thoracotomy versus fibrinolytic treatment. Eur J Cardio Thor Surg. 2002;22:595–8.

    Article  Google Scholar 

  20. Gates RL, Caniano DA, Hayes JR, Arca MJ. Does VATS provide optimal treatment of empyema in children? A systematic review J Pediatr Surg. 2004;39:381–6.

    Article  PubMed  Google Scholar 

  21. Li ST, Gates RL. Primary operative management for pediatric empyema. Arch Pediatr Adolesc Med. 2008;162:44–8.

    Article  PubMed  Google Scholar 

  22. Menon P, Rao KLN. Pediatric empyema thoracis – role of conservative management. Indian Pediatr. 2014;51:239.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Prema Menon.

Ethics declarations

Conflict of Interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Menon, P. Debate 2: Is the Management of Childhood Empyema Primarily Medical, or Surgical?. Indian J Pediatr 90, 915–919 (2023). https://doi.org/10.1007/s12098-023-04589-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-023-04589-7

Keywords

Navigation