Experience with video-assisted thoracoscopic surgery in the management of complicated pneumonia in children.
OBJECTIVE
The aim of this study was to assess the impact of video assisted thoracoscopic surgery (VATS) in the management of empyema in children.


METHODS
This report involves cases of complicated pneumonia in children requiring surgical intervention after failure of medical treatment with antibiotics, with or without drainage from November 1997 to October 1999. The impact of VATS has been studied prospectively from October 1998 when VATS was introduced. The results have been compared with the previous year when similar cases were dealt with open thoracotomy. These 2 groups of patients with VATS (V) or without VATS (O) were studied for their progress in hospital and the final outcome.


RESULTS
A total of 39 immunocompetent children with community-acquired pneumonia were studied. There were 17 cases in O and 22 in V. There were 2 conversions to open thoracotomy in V. Both of these cases required resection of the lung parenchyma for severe necrosis and bronchopleural fistula. The mean age in years was 5.3 (O) and 4.9 (V). Parameters that were significantly less in V compared with O include timing of referral (O, 13.6 days; V, 5.3 days), number of lung resections (O, 8; V, 2), blood transfusion (O, 14; V, 2), analgesia requirements (O, 7.8 days; V, 2.9 days), postoperative length of stay in hospital (O, 10.4 days; V, 4.6 days), time to become normothermic (O, 5.6 days; V, 1.7 days); and time to removal of chest drains (O, 6.0 days; V, 2.7 days). Cosmesis is superior in cases of VATS compared with open thoracotomy. All the children recovered well on follow-up with resolution of symptoms and no recurrences.


CONCLUSIONS
(1) VATS has ushered in a new era of hope for patients with complicated pneumonia. (2) Thoracotomy, lung resections, and the attending morbidity rate have decreased. (3) Patients are being referred earlier by the physicians because the management protocol is changing.
Subramaniam
R
R
Divisions of Paediatric Surgery and Paediatric Medicine (Respiratory service), K.K. Women and Children's Hospital, Singapore.
Joseph
V T
VT
Tan
G M
GM
Goh
A
A
Chay
O M
OM
D002675:Child, Preschool; D016724:Empyema, Pleural / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000150:complications*; D012008:Recurrence; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013908:Thoracotomy; D016896:Treatment Outcome