[Value of thoracoscopy in purulent pleuresies in children younger than four 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.


METHODS
Over a 4-year period we used thoracoscopic debridement in five children younger than 4 years of age with loculated thoracic empyema. All 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 1 month after discharge, the children were clinically asymptomatic; however, some degree of pleural thickening was still visible on chest X-rays.


CONCLUSIONS
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.
Service de pédiatrie, hôpital de l'Archet, 151, route Saint-Antoine-de-Ginestière, BP 3079, 06202 Nice, France.
M
M
Berlioz
H
H
Haas
M
M
Albertini
F
F
Bastiani-Griffet
J Y
JY
Kurzenne
D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015505:Chest Tubes; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods*; D004322:Drainage; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D000900:Anti-Bacterial Agents