Ali Raza Brohi*, Naseem Mengal and Abdul Lateef Leghari

Paediatric Surgery Department, Peoples University of Medical and Health Sciences Nawabshah Sind, Pakistan

*Corresponding Author: Ali Raza Brohi, Paediatric Surgery Department, Peoples University of Medical and Health Sciences Nawabshah Sind, Pakistan.

Received: April 04, 2022; Published: April 28, 2022

Abstract

Introduction: Empyema is an entity frequently encountered in pediatric age group. It is the collection of suppurative fluid in the pleural cavity secondary to bacterial pneumonia and may include other causes such as malignancies and immunological disorders. Different guidelines are available for management of empyema in adults however there is no consensus on management of empyema in children. Generally accepted treatment modalities in the order of minimal to most invasive include Antibiotics, Intercostal Chest Drainage, Fibrinolytic Therapy, Video Assisted Thoracoscopic Surgery (VATS), and open thoracotomy, with open thoracotomy usually being restricted to treating the most advanced stages i.e., stage 3.

Material and Methods: This is a retrospective descriptive study conducted at Maternal & Children Hospital; a tertiary care hospital in Nawabshah, Pakistan built with the intention to provide better maternal and child care to the surrounding urban and rural areas. The duration of this study was 6 years (January 2015 to January 2021) during which a total of 65 patients diagnosed with stage II and some stage III empyema were enrolled via non-probability consecutive sampling

Results: A total of 65 patients were enrolled during the 6-year period of the study, of which 38 were males and 27 were females, with ages ranging from 2 to 11 years and a median of 6 years. 40 patients (61.5%) underwent primary VATS, whereas the remaining 25 patients (38.5%) underwent secondary VATS (VATS after chest tube for drainage initially). The duration of stay ranged from 3 to 10 days, with a median of 6 and 8 days for Primary and Secondary VATS.

Conclusion: Primary VATS is a better modality and, in our experience, should be preferred over simple chest tube drainage where possible. As presented above, the level of complexity is generally lower if opted for earlier. The procedure is simple to learn and will also act in smoothening the learning curve for other thoracoscopic surgeries.

Keywords:   Empyma Thoracis; Children; Primary VATS

References

1. Mohajerzadeh L., et al. “Thoracotomy versus video-assisted thoracoscopy in pediatric empyema”. The Korean Journal of Thoracic and Cardiovascular Surgery 3 (2019): 125-130.
2. Shojaee S and Lee HJ. “Thoracoscopy: Medical versus surgical-in the management of pleural diseases”. Journal of Thoracic Disease 7 (2015): S339-351.
3. Shen KR., et al. THORACIC : AATS EXPERT CONSENSUS GUIDELINES : EMPYEMA “The American Association for Thoracic Surgery consensus guidelines for the management of empyema”. The Journal of Thoracic and Cardiovascular Surgery 6 (2017): e129-146.
4. Semenkovich TR., et al. “HHS Public Access” 105.6 (2019): 1589-1596.
5. Surg LA., et al. “Stage-directed therapy of pleural empyema American College of Chest Physicians”. Langenbeck's Archives of Surgery (2016).
6. Pan H., et al. “A meta-analysis of video-assisted thoracoscopic decortication versus open thoracotomy decortication for patients with empyema”. Journal of Thoracic Disease7 (2017): 2006-2014.
7. Wait MA., et al. “A randomized trial of empyema therapy” . Chest6 (1997): 1548-1551.
8. Cataneo DC., et al. “Comparative Study of Chest Tube Thoracostomy vs Video-Assisted Thoracoscopic Surgery in the Treatment of Empyema in Children”. Chest4 (2010): 328A.
9. Coote N and Kay ES. “Surgical versus non-surgical management of pleural empyema”. Cochrane Database of Systematic Reviews (2009).
10. Avansino JR., et al. “Primary operative versus nonoperative therapy for pediatric empyema: A meta-analysis”. Pediatrics6 (2005): 1652-1659.
11. Puligandla PS and Laberge JM. “Infections and Diseases of the Lungs, Pleura, and Mediastinum”. 7^th Pediatric Surgery. Elsevier Inc (2012): 855-880.
12. Sonnappa S., et al. “Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema”. American Journal of Respiratory and Critical Care Medicine 2 (2006): 221-227.
13. St Peter SD., et al. “Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial”. Journal of Pediatric Surgery1 (2009): 106-111.
14. Gates RL., et al. “Does VATS Provide Optimal Treatment of Empyema in Children? A Systematic Review”. Journal of Pediatric Surgery3 (2004): 381-386.

Citation

Citation: Ali Raza Brohi.,et al. “Role of Primary Vats for the Treatment of Empyema Thoracis in Children”. Acta Scientific Paediatrics 5.5 (2022): 37-41.

Copyright

Copyright: © 2022 Ali Raza Brohi.,et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.