title: Thoracoscopic decortication as first-line therapy for pediatric parapneumonic empyema. A case series.
abstract: OBJECTIVE
  Previous articles have promoted the early use of thoracotomy and decortication for refractory empyema. This study examines thoracoscopy and decortication at the time of initial chest tube placement in pediatric patients with parapneumonic empyema.
  
  
  METHODS
  We reviewed the medical records of 16 consecutive patients who were children with parapneumonic empyema.
  
  
  RESULTS
  Thirteen children (group 1) underwent thoracoscopic decortication and tube thoracostomy as their initial operative procedures; 3 children (group 2) had tube thoracostomy alone. In both groups, chest tubes were removed prior to their discharge to home. The mean (+/- SD) operative time for thoracoscopy was 81 +/- 19 min with no complications. On average, chest tubes were removed by postoperative day 4. The mean time to discharge was 8.3 days. Two children eventually required lobectomy. The mean operative time for chest tube placement alone was 21 +/- 3 min. Children required chest tube drainage for an average of 12.3 days. The mean time to discharge was 16.6 days. Two patients required a total of five additional operative procedures, including two additional chest tube placements, two open decortications, and one lobectomy.
  
  
  CONCLUSIONS
  Thoracoscopic decortication is effective in the early treatment of pediatric parapneumonic empyema. It facilitates visualization, evacuation, and mechanical decortication of the pleural space with no additional morbidity and may lead to reduced time for chest tube drainage, shorter hospitalization, and more rapid clinical recovery.
authors.affiliation: Department of General Surgery, Carolinas Medical Center, Charlotte, NC, USA. kent.kercher@umassmed.edu
authors.forename: K W
authors.initials: KW
authors.lastname: Kercher
authors.forename: R J
authors.initials: RJ
authors.lastname: Attorri
authors.forename: J D
authors.initials: JD
authors.lastname: Hoover
authors.forename: D
authors.initials: D
authors.lastname: Morton
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013906:Thoracoscopy