Paediatric empyema: video-assisted thoracoscopic surgery (vats) and its outcome study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20171691Keywords:
Empyema Thoracis, VATSAbstract
Background: Empyema thoracis defined as purulent pleural effusion is a common condition in children with significant morbidity and mortality. The aim of therapy for empyema is to ensure rapid recovery with a normal long term pulmonary outcome. VATS (Video-assisted thoracoscopic surgery) is gaining acceptance as a primary modality of treatment in cases of early empyema. VATS is associated with decreased morbidity and reduced hospital stay of the patient.
Methods: This is a retrospective observational study conducted in the department of pediatrics KIMS Hospital, Bengaluru from November 2014 to November 2016. In this study, review of the medical records of all the children aged 2 months to 18 years, who underwent VATS for empyema was done. The children included in the study were diagnosed with empyema thoracis based on chest X- ray, USG chest and CT chest and have undergone VATS by pediatric surgical team.
Results: The median age of presentation was 4.1 yrs. 18 children were malnourished of which 3 had severe malnutrition. Male to female ratio was 1:1. Most common symptoms were fever (96%), cough (84%), respiratory distress (61%) and chest pain (48%). All patients had parapneumonic effusions and received antibiotics before undergoing surgery. Post-operative supplemental oxygen was required for 2.5±0.5 days. Chest tubes were removed in 4.53±0.7days and duration of stay in hospital was 8.26±1.77 days. All patients were afebrile before discharge and were discharged on oral antibiotics. Follow-up data showed that symptoms resolved in 24 children, 2 children had complications, one child had a pneumothorax and another had a broncho-pleural fistula.
Results: Most common symptoms were fever (96%), cough (84%), respiratory distress (61%) and chest pain (48%). All patients had parapneumonic effusions and received antibiotics before undergoing surgery. Post-operative supplemental oxygen was required for 2.5±0.5 days. Chest tubes were removed in 4.53±0.7days and duration of stay in hospital was 8.26±1.77 days. All patients were afebrile before discharge and were discharged on oral antibiotics.
Conclusions: These results suggest that primary operative therapy in the form of VATS is an effective treatment option for children with empyema. VATS is associated with a lower in-hospital mortality rate, re-intervention rate, length of stay and duration of tube thoracostomy.
References
Menon P, Kanojia RP, Rao KLN. Empyema thoracis: Surgical management in children. Journal of Indian Association of Pediatric Surgeons. 2009;14(3):85-93.
Cox M. Pediatric Empyema; Emphasis on Thoracoscopic Treatment. SAGES U, TV S. Available from: https://www.sages.org/wiki/pediatric-empyema-emphasis-on-thoracoscopic-treatment/#
Kumar A, Sethi GR, Mantan M, Aggarwal SK, Garg A. Empyema thoracis in children: a short term outcome study. Indian Pediatr. 2013;50:879-82.
Avansino JR, Goldman B, Sawin RS, Flum DR. Primary operative versus nonoperative therapy for pediatric empyema: A meta-analysis. Pediatrics. 2005;115:1652-9.
Zampoli M, Zar HJ. Empyema and parapneumonic effusions in children: an update. SA J Child Health. 2007;1:121-8.
Ris HB, Krueger T. Video-assisted thoracoscopic surgery and open decortication for pleural empyema. Multimedia Manual Cardiothoracic Surg. 2004:000273.
Striffeler H, Ris HB, Wu¨ rsten HU, Im Hof V, Stirnemann P, Althaus U. Video-assisted thoracoscopic treatment of pleural empyema. A new therapeutic approach. Eur J Cardiothorac Surg. 1994;8:585-8.
Hurley JP, McCarthy J, Wood AE. Retrospective analysis of the utility of video-assisted thoracic surgery in 100 consecutive procedures. Eur J Cardiothorac Surg. 1994;8:589-92.
Angelillo Mackinlay TA, Lyons GA, Chimondeguy DJ, Piedras MA, Angaramo G, Emery J. VATS debridement versus thoracotomy in the treatment of loculated postpneumonia empyema. Ann Thorac Surg. 1996;61:1626-30.
Striffeler H, Gugger M, Im Hof V, Cerny A, Furrer M, Ris HB. Video-assisted thoracoscopic surgery for fibrinopurulent pleural empyema in 67 patients. Ann Thorac Surg. 1998;65:319-23.
Cassina PC, Hauser M, Hillejan L, Greschuchna D, Stamatis G. Video-assisted thoracoscopy in the treatment of pleural empyema: stage-based management and outcome. J Thorac Cardiovasc Surg. 1999;117:234-38.
Waller DA, Rengarajan A. Thoracoscopic decortication: a role for video-assisted surgery in chronic postpneumonic pleural empyema. Ann Thorac Surg 2001;71:1813-16.
Suzuki T, Kitami A, Suzuki S, Kamio Y, Narushima M, Suzuki H. Video-assisted thoracoscopic sterilization for exacerbation of chronic empyema thoracis. Chest. 2001;119:277-80.
Satpathy SK, Behera CK, Nanda P. Outcome of parapneumonic empyema. Indian J Pediatr. 2005;72:197-9.
