Surgical strategy of empyema thoracis in children: open thoracotomy v/s video assisted thoracoscopy

Authors

  • Pranav Jadhav Department of Pediatric Surgery, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
  • Sanjay Raut Department of Pediatric Surgery, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
  • Manish Kumar Kashyap Department of Pediatric Surgery, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
  • Riddhi Ajay Bora Department of Pediatric Surgery, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20184741

Keywords:

Open thoracotomy, Video Assisted Thoracoscopy (VATS)

Abstract

Background: Empyema is the suppuration within the pleural cavity, most commonly a complication of acute bacterial pneumonia. It is one of the most common diseases in children in India. Prognosis is excellent, provided appropriate treatment is administered early in the course of the disease.

Methods: This study examines treatment of complex empyema thoracis between June 1, 2016, and April 30, 2018. Total number of patients were 30 cases in open thoracotomy and 30 in VATS in treatment of their disease. Effusion etiology was distributed as follows: infectious, neoplastic-associated, traumatic.

Results: A total of 30 patients underwent VATS debridement and open thoracotomy for treatment of empyema thoracis. The median postoperative hospital stay was 10.31±3.751 days in case of VATS and 4.41±1.593 days in case of open thoracotomy. Median estimated blood loss in case of VATS was 78±15.634 ml and in case of open thoracotomy was 15.97±5.871 ml. Mean operative time was 82.86±17.293 minutes in case VATS and 77.59±13.38 minutes in case of open thoracotomy.

Conclusions: VATS might be comparable or even better than open thoracotomy in terms of operative time, postoperative hospital stay, chest tube duration, prolonged air leak rate, morbidity and mortality. But referring to the relapse rate, there was no statistical significance.

References

Krenke K, Urbankowska E, Urbankowski T, Lange J, Kulus M. Clinical characteristics of 323 children with parapneumonic pleural effusion and pleural empyema due to community acquired pneumonia. J Infect Chemother. 2016;22:292-7.

Singh M, Singh SK, Chowdhary SK. Management of empyema thoracic in children. Indian Pediatr. 2002;39:145-57.

Gupta AK, Lahoti BK, Singh S, Mathur RK, Mishra H, Wadhera S. A study on comprehensive management of acute and chronic empyema thoracis in the pediatric age group and their outcome. Internet J Surg. 2008;14:1.

Mackinlay TA, Lyons GA, Chimondeguy DJ, Piedras MA, Angaramo G, Emery J. VATS debridement versus thoracotomy in the treatment of loculated postpneumonia empyema. Ann Thorac Surg. 1996;61:1626-30.

Luh SP, Chou MC, Wang LS, Chen JY, Tsai TP. Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: outcome of 234 patients. Chest. 2005;127:1427-32.

Scarci M, Zahid I, Billé A. Is video-assisted thoracoscopic surgery the best treatment for paediatric pleural empyema? Interact Cardiovasc Thorac Surg. 2011;13:70-6.

Chan DT, Sihoe AD, Chan S, Tsang DS, Fang B, Lee TW, et al. Surgical treatment for empyema thoracis: is video-assisted thoracic surgery ‘‘better’’ than thoracotomy? Ann Thorac Surg. 2007;84:225-31.

Cardillo G, Facciolo F, Giunti R, Gasparri R, Lopergolo M, Orsetti R, et al. Videothoracoscopic treatment of primary spontaneous pneumothorax: a 6-year experience. Ann Thoracic Surg. 2000;69(2):357-61.

Martínez-Ferro M, Duarte S, Laje P. Single-port thoracoscopy for the treatment of pleural empyema in children. J Pediatr Surg. 2004;39:1194-6.

Bishay M, Short M, Shah K, Nagraj S, Arul S, Parikh D, et al. Efficacy of video-assisted thoracoscopic surgery in managing childhood empyema: A large single-centre study. J Pediatr Surg. 2009;44:337-42.

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Published

2018-11-28

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Original Research Articles