2006
DOI: 10.1542/peds.2005-2719
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Therapy of Parapneumonic Effusions in Children: Video-Assisted Thoracoscopic Surgery Versus Conventional Thoracostomy Drainage

Abstract: The outcomes of this study strongly suggest that primary video-assisted thoracoscopic surgery for evacuation of parapneumonic effusions is superior to conventional thoracostomy drainage.

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Cited by 128 publications
(108 citation statements)
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“…Both approaches remove pus and fluid from the pleural space and reduce the need for open drainage and decortication [62,63], and are associated with reduced morbidity compared to open thoracotomy [63,64]. However, children who undergo surgery still require a chest drain post-operatively and there is debate as to whether there is any reduction in hospital stay [65][66][67] compared with nonsurgical management. Two prospective randomised studies comparing VATS with chest drains plus intrapleural fibrinolytics found no difference in treatment failure rate [66,68] and, although VATS failure rates in a subsequent study undertaken in a different centre were significantly better (7%) [69], the additional expense [68,70] and limited availability [69] of VATS suggest that it should currently be considered as a second-line treatment option.…”
Section: Parapneumonic Effusion/empyemamentioning
confidence: 99%
“…Both approaches remove pus and fluid from the pleural space and reduce the need for open drainage and decortication [62,63], and are associated with reduced morbidity compared to open thoracotomy [63,64]. However, children who undergo surgery still require a chest drain post-operatively and there is debate as to whether there is any reduction in hospital stay [65][66][67] compared with nonsurgical management. Two prospective randomised studies comparing VATS with chest drains plus intrapleural fibrinolytics found no difference in treatment failure rate [66,68] and, although VATS failure rates in a subsequent study undertaken in a different centre were significantly better (7%) [69], the additional expense [68,70] and limited availability [69] of VATS suggest that it should currently be considered as a second-line treatment option.…”
Section: Parapneumonic Effusion/empyemamentioning
confidence: 99%
“…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
“…Three of the single-centre trials reported the use of pain medication after each procedure, but none assessed patient-reported pain using validated questionnaires or other assessments. [11][12][13] One of the trials noted decreased duration of narcotic use with VATS compared with CTWF (2.2 d v. 7.6 d, p = 0.043), 12 but 2 others did not report any differences. 11,13 Outcomes related to pain were not reported in the recent multicentre RCT.…”
Section: Limitationsmentioning
confidence: 97%
“…A systematic review from 2010 of 3 small, randomized controlled trials (RCTs) comparing VATS and CTWF revealed no significant differences in outcomes. 7,[10][11][12] Both approaches were associated with similar length of stay in hospital and rates of treatment failure, defined as the need for additional chest tubes or surgery. Since then, a fourth single-centre RCT comparing VATS and CTWF was published.…”
mentioning
confidence: 98%