Videothoracoscopic surgery before and after chest tube drainage for children with complicated parapneumonic effusion

Knebel, Rogério; Fraga, José Carlos Soares de; Amantéa, Sérgio L.; Isolan, Paola Brolin Santis

doi:10.1016/j.jpedp.2017.08.023

Cited by 3 publications

(6 citation statements)

References 27 publications

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“…In multicenter studies from Brazil they found a decrease of postoperative hospital length of stay in patients referred straight for thoracoscopy comparing those with initial chest tube placement and then thoracoscopy, but overall time to resolution was similar in both groups. It supports the suggestion that tube placement was not curative at all [ 6 ]. Even the bacteriology sample was usually useless as most of the examinations were sterile, both in our material and the literature [ 7 ].…”

Section: Discussionsupporting

confidence: 87%

Pleural empyema in children - benefits of primary thoracoscopic treatment.

Barglik¹,

Grabowski²,

Korlacki³

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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Introduction Pleural empyema is the condition of the pleural cavity when initially sterile pleural effusion has become infected. In the majority of cases, it is of parapneumonic origin. Parapneumonic effusions and pleural empyemata usually continuously progress in severity. The American Thoracic Society divides them into three stages: exudative, fibrinopurulent and organizing. The therapy depends on the stage. Aim To assess whether thoracoscopy should be considered better than conservative treatment and to assess the feasibility of the thoracoscopic approach to the 3 rd phase of pleural empyema. Material and methods The clinical course of 115 patients treated from 1996 to 2017 was analyzed. 45 patients operated on thoracoscopically after the failure of conventional treatment were compared with 70 patients treated by primary thoracoscopic drainage and decortication. Results The results of the study demonstrated that patients treated primarily by thoracoscopy had a shortened length of hospital stay (16.6 vs. 19.3 days), reduced drainage time (7.9 vs. 9.8 days), and shorter time of general therapy (31.8 vs. 38.0 days). They required fibrinolysis less frequently (12.8 vs. 26.7% of patients) and had reduced risk of reoperation (10 vs. 15.6% of cases). Operation time in the 3 rd stage was only 15 min longer. The difference in length of hospital stay was only 0.8 days in favor of less severe cases. Conclusions The thoracoscopic approach is safely feasible in the 3 rd stage of pleural empyema and should be considered as the preferred approach. Furthermore, the post-operative stay and general course of the disease are milder whenever surgery would not be delayed by prolonged conservative treatment attempts.

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Section: Discussionsupporting

confidence: 87%

Pleural empyema in children - benefits of primary thoracoscopic treatment.

Barglik¹,

Grabowski²,

Korlacki³

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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“…Several previous studies on early VATS for pleural empyema in pediatric patients have confirmed efficacy of early VATS in reduced length of hospital stay, shorter duration of postoperative chest tube drainage, faster recovery, faster cessation of pyrexia, and very low conversion rate to open surgery. [4][5][6][7] On the other hand, some previously published studies have also reported successful outcomes of treatment of pediatric pleural empyema with nonoperative management. 8 The role of fibrinolytic therapy in the treatment of pediatric pleural empyema is not clear.…”

Section: Discussionmentioning

confidence: 99%

“…11 Many studies confirmed that primary VATS is superior to intercostal chest tube insertion. 6,7,11,12 Primary VATS showed several benefits including shorter length of chest drainage, shorter hospital stay, and lower hospital costs. 11,12 Comparing operative and nonoperative treatment, significant benefits have been reported when operative treatment has been used.…”

Section: Discussionmentioning

confidence: 99%

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Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome

Pogorelić

Bjelanović

Gudelj

et al. 2020

Thorac Cardiovasc Surg

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Objectives The aim of this study was to observe outcomes of early decortication in a treatment of pleural empyema using video-assisted thoracoscopic surgery (VATS). Methods The case records of 21 pediatric patients who underwent VATS for empyema between 2009 and 2019 were retrospectively reviewed. Patients were observed based on demographic, laboratory, and clinical data, as well as treatment outcomes. Results Out of a total of 59 patients treated for pleural empyema, 21 (10 male and 11 female) children with a median age of 5 years (interquartile range [IQR] 2.8; 6.0) received VATS. The empyema was classified as stage I in 2 patients (9.5%), stage II in 4 patients (19%), and stage III in 15 patients (71.5%). Median surgical time was 60 minutes (IQR 50; 90). There were 2 (9.5%) postoperative complications and 1 recurrence (4.8%). Children treated in stages I and II showed significantly better postoperative results compared with the children treated in stage III. Length of hospital stay (8 vs. 10 days; p = 0.01), length of intensive care unit stay (1 vs. 5 days; p < 0.001), duration of chest tube drainage (4 vs. 6 days; p = 0.043), duration of postoperative fever (1.5 vs. 4 days; p = 0.001), and surgical time (40 vs. 70 minutes; p < 0.001) were significantly shorter in children operated in stages I and II than in stage III. Conclusion Early decortication using a VATS is a successful, effective, and easily performed surgical method in the treatment of pediatric pleural empyema, as well as a method that significantly improves recovery time and shortens the hospital stay.

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“…It is associated with less postoperative pain and a shorter duration for recovery than open thoracotomy [106]. It is a safe procedure in children and is often indicated in the fibropurulent stage when chest tube drainage is unsuccessful or if the patient is not responding well to combine antibiotics with a chest tube or pigtail catheter [107][108][109]. VATS has a shorter duration of chest tube drainage than simple chest tube drainage; presently, earlier intervention with VATS is recommended once [110][111].…”

Section: Surgerymentioning

confidence: 99%

Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines

Al-Shamrani¹

2020

AJP

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Videothoracoscopic surgery before and after chest tube drainage for children with complicated parapneumonic effusion

Cited by 3 publications

References 27 publications

Pleural empyema in children - benefits of primary thoracoscopic treatment.

Pleural empyema in children - benefits of primary thoracoscopic treatment.

Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome

Management of Complicated Pneumonia in Children: Evidence Beyond Guidelines

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