Surgical Outcome of Video-Assisted Thoracoscopic Surgery (VATS) in Paediatric Patients with Complicated Parapneumonic Effusions

Video-assisted thoracoscopic surgery (VATS) has been widely used in the last decade; however, it is not a commonly performed procedure in paediatric patients. Surgery entails different approaches such as VATS or conventional thoracotomy/thoracostomy drainage for complicated parapneumonic effusions. However, to date, a consensus on the most appropriate treatment for this has not been reached. The aim of this study is to investigate the clinical significance of VATS in the management of complicated parapneumonic effusion in children with failure of conventional chest tube therapy. The present study is a case series analysis of paediatric patients (n = 30) of parapneumonic effusions aged 2 to 16 years who had a failure of conventional chest tube therapy of more than 7 days, underwent video-assisted thoracoscopic surgery. A detailed history, clinical examination, preoperative workup, operative findings, operative procedure, postoperative course, and follow-up were recorded. Result showed that mean age was 10.10 SD 2.578 years; 53.3% were boys and 46.7% were girls. The most common symptom was cough involving 86.7% of patients, while other symptoms were fever, chest pain, and shortness of breath. Pleural effusion and loculations were present in all patients, while consolidation was present in 50%. The most commonly affected side was the left pleural cavity (66.7%). The majority of patients required 100-110 min for surgery with an average hospital stay of 5 days. None of the patients experienced any intraoperative complications, and none of the patients were converted to open thoracotomy. An intercostal drain was removed on the 3rd day postoperatively in most patients (66.7%). Opioid analgesia was not required; however, NSAIDs (paracetamol) were given in some patients. It could be concluded that video-assisted thoracoscopic pleural evacuation can be recommended as the intervention in paediatric parapneumonic effusions and empyema, specifically in patients who do not require emergent drainage. It is a safe and effective procedure in children that offers rapid recovery with a shorter duration of chest tube drainage and a reduction of hospital stay in less experienced centers.