title: Thoracoscopy for empyema in children.
abstract: METHODS
  During a 19-month period, seven children with empyema underwent thoracoscopy. The average age was 7.5 years (range, 3 to 15 years) and the duration of illness before surgery 16.5 days (range, 7 to 42 days). All patients received preoperative antibiotics, underwent ultrasound or CT scan and thoracentesis. Two patients had preoperative intercostal tube drainage. Indications for operations were lack of response to antibiotics of loculation of pleural fluid on imaging. All procedures were performed under general anesthesia with a single lumen tube.
  
  
  RESULTS
  Thoracoscopy allowed for good access and complete clearance in two patients. In the remaining patients, thoracoscopy failed to clear the disease because of difficulty with access, instrumentation, and clearance of thick debris. These patients underwent thoracotomy with two requiring decortication.
  
  
  CONCLUSIONS
  This experience suggests that even in the early stage of empyema formation, thoracoscopy is not as effective as thoracotomy. Larger experience and studies are required to define the place of thoracoscopy in the management of childhood empyema.
authors.affiliation: Department of Paediatric Surgery, St James's University Hospital and The General Infirmary, Leeds, England.
authors.forename: H A
authors.initials: HA
authors.lastname: Steinbrecher
authors.forename: A S
authors.initials: AS
authors.lastname: Najmaldin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000601:surgery*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000601:surgery*; D013906:Thoracoscopy; D013908:Thoracotomy; D016896:Treatment Outcome