Efficacy of video-assisted thoracoscopic surgery in managing childhood empyema: a large single-centre study

Bishay, Mark; Short, Melissa; Shah, Kant; Nagraj, Shobhana; Arul, G. Suren; Parikh, Dakshesh; Jawaheer, Girish

doi:10.1016/j.jpedsurg.2008.10.083

Cited by 47 publications

(56 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4,[14][15][16][17][18][19][20] Isto levou a que a VATS fosse recomendada como tratamento primário de DPP complicados, assim que o diagnóstico fosse feito. A evidência atual sugere que o tratamento dos DPP complicados através da instilação intrapleural de fibrinolítico é equivalente ao tratamento cirúrgico.…”

Section: Discussionunclassified

Fibrinolíticos no Tratamento de Derrames Pleurais Complicados

Coelho

Pereira

et al. 2016

Acta Med Port

View full text Add to dashboard Cite

Discussão: Na nossa revisão a taxa de sucesso terapêutico encontra-se dentro do esperado, com uma percentagem de falência inferior ao descrito na literatura. Apresentamos a instilação intrapleural de fibrinolítico e a toracoscopia videoassistida num mesmo protocolo de atuação, tendo como primeira linha terapêutica o fibrinolítico. Conclusão: A opção terapêutica apresentada teve uma baixa taxa de falência e permitiu evitar um procedimento cirúrgico mais agressivo. Consideramos que esta é uma opção de tratamento eficaz e que, na nossa amostra, cursou com uma baixa taxa de sequelas. Palavras-chave: Derrame Pleural; Empiema Pleural; Fibrinolíticos. ABSTRACT Introduction:The treatment of complicated pleural parapneumonic effusions with intrapleural instillation of fibrinolytics, has shown similar results as surgical treatment. The present study aimed to evaluate the results of the use of intrapleural instillation of fibrinolytics in the treatment of complicated pleural parapneumonic effusions, in patients followed in our hospital. Material and Methods:A retrospective review of all the patients (aged between one month and 18 years) diagnosed with complicated parapneumonic effusions, which had chest drain insertion with intrapleural instillation of fibrinolytic, between January 2005 and December 2013, was undertaken.Results: A total of 37 patients were identified. Mean duration of hospital stay was 17 ± 7.60 days. Chest drain was placed in the first 48 h of hospital admission in most of the patients (89.2%), with a mean of six days of drainage. Treatment failure was reported in 2.7% of cases and was related with effusion recurrence. This patient underwent video-assisted thoracoscopic surgery with the need to convert to open thoracotomy. A favorable outcome was achieved in 96.9 % of cases. Discussion: In our review, therapeutic success rate was as expected, with a failure rate below those reported in literature. We present intrapleural instillation of fibrinolytics and video-assisted thoracoscopic surgery as part of the same protocol, in which fibrinolytic therapy is the first-line treatment. Conclusion:The therapeutic option presented shows a low failure rate and avoids a more aggressive surgical procedure. We consider this an effective treatment option, with low sequelae rate.

show abstract

Section: Discussionunclassified

Fibrinolíticos no Tratamento de Derrames Pleurais Complicados

Coelho

Pereira

et al. 2016

Acta Med Port

View full text Add to dashboard Cite

show abstract

“…The conversion rate in our study, according to the fact that we also included advanced (stage III) cases of empyema, was not very high -25.4%. Conversion to the thoracotomy is usually considered if there is impossible to enter the pleural cavity due to firm adhesions, completely dissect the peel from the underlying lung surfaces to achieve enough lung reexpansion or in cases of severe bleeding or significant air leak (12,(18)(19)(20)(21)23). The first two were the main reasons for conversion in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, there is a lack of data regarding the optimal timing of surgical intervention, so there is no consensus regarding this issue. Some recent studies identified that delayed referral to surgery or longer anamnesis lead to higher conversion rate and consequently increases morbidity and mortality (1,3,12,15,21,24,25,27). Chung and colleagues in their recent retrospective analysis of 120 cases of VATS empyemectomies stated that patients with the symptom duration of less than four weeks showed better early results compared to those with the symptom duration greater than four weeks (16).…”

Section: Discussionmentioning

confidence: 99%

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Jagelavičius¹,

Jovaišas²,

Matačiūnas³

et al. 2015

AML

View full text Add to dashboard Cite

Background. Empyema remains a challenging entity for thoracic surgeons. The aim of this study was to evaluate preoperative predictors for unsuccessful thoracoscopic empyemectomy and postoperative complications.Materials and methods. There were 71 patients prospectively included in the study during the period from January 2011 to June 2014 in whom we performed thoracoscopic empyemectomy. Two main outcomes were evaluated: conversion and complications. Preoperative factors that could predict these outcomes were analyzed.Results. Conversion to open thoracotomy was required in 25.4% of cases. Fourteen (19.7%) patients had postoperative complications. The multivariate analysis showed that the time of illness (odds ratio 1.1; confidence interval 1.1-1.2), normal temperature on admission (odds ratio 11.2; confidence interval 1.5-85.4) and frank pus found on thoracocentesis (odds ratio 6.9; confidence interval 1.6-29.4) had a significant influence on conversion from thoracoscopy to open thoracotomy. Pain (odds ratio 0.01; confidence interval <0.01-0.6), subfebrile temperature on admission (odds ratio 10.1; confidence interval 1.4-73.5), positive pleural culture (odds ratio 8.5; confidence interval 1.0-70.1), Charlson comorbidity index (odds ratio 2.3; confidence interval 1.1-4.8), empyema volume (odds ratio 1.002; confidence interval 1.000-1.005) and empyema density (odds ratio 0.8; confidence interval 0.6-1.0) had a significant influence on postoperative complications.Conclusions. Longer time of illness, normal temperature on admission and frank pus in pleural aspiration increase probability of conversion. No pain, subfebrile temperature, higher Charlson comorbidity index on admission, positive pleural culture, higher volume and lower density of empyema on computed tomography scan increase probability of postoperative complications.

show abstract

“…Aún no existe consenso acerca del tratamiento de primera línea en los niños con este diagnóstico: si debe realizarse primero manejo médico (antibióti-cos y toracostomía) o manejo quirúrgico con la TVA (12). En nuestro estudio, la indicación para utilizar la TVA fue la ausencia de mejoría clínica durante el manejo médico (antibióticos más toracostomía) o el hallazgo de evidencia imagenológica de derrame paraneumónico complicado (estadio II y III).…”

Section: Análisis Y Discusiónunclassified

“…En nuestro estudio, la indicación para utilizar la TVA fue la ausencia de mejoría clínica durante el manejo médico (antibióticos más toracostomía) o el hallazgo de evidencia imagenológica de derrame paraneumónico complicado (estadio II y III). Esta indicación difiere de la referida en otros estudios, como por ejemplo el de Bishay y colaboradores, en el que se realizaba toracoscopia como primer manejo en todos los pacientes (12). En nuestro estudio, la mitad de los pacientes (n= 9) recibieron un manejo inicial no quirúrgico, en 4 de ellos iniciado previamente en otras instituciones de menor complejidad y en los 5 restantes, en nuestra institución.…”

Section: Análisis Y Discusiónunclassified