Thoracoscopy in the management of thoracic empyema in children younger than 4 years

Video-assisted thoracoscopic surgery is widely performed in adults but there are few publications concerning the paediatric population. The objective is to effect optimal adhesiolysis of post-pneumonic loculated empyema with lower morbidity. Patients and methods. - Over a 4-year period we used thoracoscopic debridement in five children younger than 4 years of age with loculated thoracic empyema, Ail patients failed initial treatment including antibiotics and chest tube drainage. Early sonographic evaluation of the empyema organization guided the most appropriate moment for the intervention. The average duration of tube drainage after thoracoscopy was 4 days (range: 1 to 7 days). Results. - All patients made an uneventful postoperative recovery. At a follow-up visit I month after discharge, the children were clinically asymptomatic; however, some degree of pleural thickening was still visible on chest X-rays. Conclusion. - In skilled hands, thoracoscopy is a safe procedure for post-pneumonic empyema in young children, providing a rapid clinical and radiological recovery with a good cosmetic result. (C) 2001 Editions scientifiques et medicales Elsevier SAS.