Is open thoracotomy still a good treatment option for the management of empyema in children?

Alexiou, Christos; Goyal, Anuj; Firmin, Richard K.; Hickey, Mark

doi:10.1016/s0003-4975(03)01076-2

Cited by 38 publications

(33 citation statements)

References 19 publications

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“…Atexions et al reported a series of 44 children undergoing early thoracotomy revealed very short duration of fever (mean 1 day) and an average of 3 days until chest tube removed. 6 This series authors point out that their mean hospital stays were shorter than series of children manage with VATS. Ashish k. Gupta et al reported a series of 60 paediatric thoracis empyema cases thoracotomy and decortication revealed a more rapid recovery with a decrease number of chest tube days and decreased length of hospital stay success rate 96.6%.…”

Section: Resultsmentioning

confidence: 90%

“…5 Many retrospective case series have suggested that children who experience failure of conventional chest tube therapy exhibit improvement after thoracotomy or VATS, especially if the procedure is performed early, based on these reports, many paediatric surgeons have come to consider primary VATS a better approach for children suffering from thoracis empyema, A recent meta-analysis suggested that primary surgical intervention for paediatric thoracis empyema effusions was best which was prospective, randomized study done by waite et al in adults. 6 However, to our knowledge there has never been a prospective paediatric study to confirm this hypothesis. The purpose of this study was to prospectively compare multiple variables in paediatric patients undergoing primary VATS versus conventional thoracostomy drainage of thoracis empyema.…”

Section: Introductionmentioning

confidence: 92%

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Prospective comparative study of video assisted thoracoscopic surgery versus conventional thoracostomy drainage in emyema thoracis in paediatric age group

2015

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Background: Approximately 1.2 million people per year are affected by pneumonia in the United States. In paediatric patients, thoracis empyema complicates pneumonia 36% to 57% of the time with a range of incidence between 0.4 and 6.0 cases per 1000 paediatric admissions. Many retrospective case series have suggested that children who experience failure of conventional chest tube therapy exhibit improvement after thoracotomy or video assisted thoracoscopic surgery (VATS), especially if the procedure is performed early, based on these reports, many paediatric surgeons have come to consider primary VATS a better approach for children suffering from thoracis empyema, A recent meta-analysis suggested that primary surgical intervention for paediatric thoracis empyema effusions was best which was prospective, randomized study done by Waite et al in adults.Methods: The present prospective study was conducted in a large teaching hospital that is a tertiary centre, department of surgery pediatric surgery unit, Pt. J. N. M. medical college & Dr. B.R Ambedkar hospital, Raipur (C.G.), India, in the year 2010. Using a random number method, patients were assigned either to a primary conventional thoracostomy arm or to a VATS arm. Those randomly assigned to the conventional thoracostomy arm had chest rube placement within 24 hours of empyema detection. If the chest radiograph obtained within 24 hours of the procedure showed significant clearing, then the thoracostomy tube was left in place until it drained <1 mL/per day for >24 hours. If there was incomplete resolution of the effusion on the follow-up chest radiograph [obvious locations] and the patient was not clinically improving, then the patient was evaluated for rescue VATS or open thoracotomy. A sample size of 30 was chosen to have an 80% power to detect a predicted deference of 4 days in the mean length of hospitalization. Results: In this study, 30 patients included between 0 to 18 years of age youngest patient was 1 year and the oldest was 14 years. Six patients (20%) were between 2 to 3 years of age. In this study, 20 (67%) were male and 10 (30%) patients were females. Out of all 30 patients, in this study 20 (67%) were male and 10 (30%) patients were females.[Sixteen (53.3%) patients had right sided disease and fourteen (46.6%) had left sided disease, no patient was found having bilateral disease. All the thirty patients were empyema Thoracis. Using a random number method, patients were assigned either to a primary conventional thoracostomy arm or to a VATS arm. Conclusions: In the present study we found that empyema thoracis can be successfully treated by thoracoscopic decortications if encountered in early phase of the disease process. To conclude early intervention of empyema thoracis with thoracoscopic decortications seems to be the worldwide accepted modality of choice.

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Section: Resultsmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 92%

Prospective comparative study of video assisted thoracoscopic surgery versus conventional thoracostomy drainage in emyema thoracis in paediatric age group

2015

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“…However, cultures are slow and can have false-negative results because of small sample volume, previous antibiotic therapy, or unsatisfactory conditions of transport and storage, which can impair the viability of pathogens, particularly Streptococcus pneumoniae. It is possible to improve diagnostic sensitivity by using broad-range 16 S rDNA PCR and sequencing [19], which permit detection of potentially all bacterial etiologies, or by using amplification of species-specific genes, such as the pneumolysin gene (ply) of S. pneumoniae [18] [20]. Given the economic context, these techniques are difficult to be carried out in a poor-resource country.…”

Section: Discussionmentioning

confidence: 99%

Management for Pediatric Pleural Empyema in Resource-Poor Country: Is Chest Tube Drainage with Antiseptic Lavage-Irrigation Better than Tube Thoracostomy Alone?

Togo¹,

Ouattara²,

Sangaré³

et al. 2015

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Background: Drainage by chest tube thoracostomy is widely used in treatment of early empyema thoracis in children, but drainage with antiseptic lavage-irrigation is more frequent in our context since the last 20 years. This study was to determine which was more effective in our experience comparing chest tube drainage with catheter antiseptic lavage-irrigation versus drainage by chest tube thoracostomy alone in the management of empyema thoracis in children. S. Togo et al. 542situ, less cost and better outcome of stage 2 empyema diseases than a treatment strategy that utilizes chest tube thoracostomy alone.

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“…Thus, expanded surgical intervention is needed, involving thoracotomy, open drainage, and extensive decortication [1,16,20,28]. Administration of fibrinolytic agents into the pleural cavity proves ineffective.…”

Section: Discussionmentioning

confidence: 99%

The role of thoracoscopy in the treatment of pleural empyema in children

Dzielicki

Korlacki

2006

Surg Endosc

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Thoracoscopy can offer good visualization and cleansing of the empyema chambers, establishing efficient drainage even for patients with advanced stages of pleural empyema. Thoracoscopy enables collection of material not only for bacteriologic, but also for histopathologic examination. The method is minimally invasive, and risk for complication is comparable with that for classical thorax drainage.

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Is open thoracotomy still a good treatment option for the management of empyema in children?

Cited by 38 publications

References 19 publications

Prospective comparative study of video assisted thoracoscopic surgery versus conventional thoracostomy drainage in emyema thoracis in paediatric age group

Prospective comparative study of video assisted thoracoscopic surgery versus conventional thoracostomy drainage in emyema thoracis in paediatric age group

Management for Pediatric Pleural Empyema in Resource-Poor Country: Is Chest Tube Drainage with Antiseptic Lavage-Irrigation Better than Tube Thoracostomy Alone?

The role of thoracoscopy in the treatment of pleural empyema in children

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