Thoracoscopic debridement for empyema thoracis
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In brief
In brief
This retrospective study of 106 pediatric empyema cases demonstrates an 88% success rate for primary thoracoscopic debridement, with most failures attributed to pulmonary necrosis and bronchopleural fistula requiring conversion to open thoracotomy with serratus anterior flap reconstruction.
Written by the GCMD Library team from the article.
Background/Purpose
The success rate of early thoracoscopic debridement (TD) for childhood empyema was reviewed in light of the increasing reported incidence of empyema associated with pulmonary necrosis (PN).
Methods
Data were collected from 106 patients who underwent thoracoscopic intervention from 2010 to 2016. Twenty additional patients with severe PN/Bronchopleural Fistula (BPF) were not suitable for TD requiring thoracotomy and Serratus anterior digitation flap.
Results
106 patients with a median age of 4 years (IQR 2–6 years) were considered for TD as primary intervention of which 3 needed conversion to thoracotomy. TD alone was successful in 93/106 however, 10 patients required subsequent minithoracotomy for PN/BPF (managed with Serratus anterior digitation flap). Counting conversions as failure, the overall success rate of TD was 88%. No statistical difference was demonstrable in success rate compared to our previous series (93% (106/114) vs 88% (93/106)).
Conclusions
Primary TD in pediatric empyema is associated with an excellent outcome achieving adequate drainage and full expansion of the lung. The majority of failures in our series were attributable to PN/BPF, requiring thoracotomy and Serratus anterior digitation flap. This is likely a consequence of the increasing incidence of necrotizing pneumonia.
Level of evidence
Level IV.