Thoracoscopic treatment of pediatric lung abscesses

Complicated pneumonia in children

“…Surgical intervention has, in the past, been associated with significant morbidity [77,83] and was recommended as an intervention only if prolonged medical therapy was unsuccessful [84] or if there was respiratory compromise, such as mediastinal shift, necessitating mechanical ventilation. However, two recent reports suggest that insertion of a pigtail catheter at the time of presentation and initial CT-guided percutaneous aspiration [77] or thoracoscopic drainage [85] can significantly reduce duration of hospital stay and antibiotic therapy, but this has yet to be confirmed by larger studies. It is estimated that 90% of children with primary lung abscess will respond to medical management and make a full recovery although empyema, pneumothorax and bronchopulmonary fistulae (defined as an abnormal connection between the pleural space and bronchial tree) are recognised sequelae [74].…”

Pediatric Thoracic Surgery

“…If acid suppression is chosen as a treatment or for a limited trial, a PPI that blocks acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium ATPase pump is generally preferred [66]. Infants and younger children metabolize PPIs more rapidly than older children and require higher perkilogram dosing than older individuals [67].…”

“…The most accurate method uses fluoroscopy to measure the distance between a dilator placed in the upper esophageal pouch and an endoscope placed through the gastrostomy site and driven into the blind distal esophageal pouch [66]. This often occurs with pure esophageal atresia or esophageal atresia with a proximal fistula.…”

“…Thoracoscopic resection has been shown to be possible and safe into the hands of experienced pediatric surgeons [63][64][65][66][67] probably with longer operative times but with similar results and less visible scars [64,68]. Thoracoscopy can also be used for decompression of the cysts in selected cases [69].…”

Surgical management for complications of pediatric lung injury

“…Despite the inherent higher surgical risk of extensive resection in these patients, morbidity and mortality for this aggressive approach are comparable to that achieved in immunocompetent patients undergoing less extensive resection. 18 Successful thoracoscopic drainage of pulmonary abscess has been described 19 ; however, comparisons of efficacy between percutaneous and thoracoscopic drainage techniques are lacking.…”