title: [Surgical treatment of parapneumonic pleural effusion and its complications].
abstract: OBJECTIVE
  Surgical treatment of parapneumonic pleural effusion in children is controversial. The type of intervention is based mainly on personal experience and on the small number of reported cases. This article aims at presenting a literature review and the authorś experience in the surgical management of parapneumonic pleural effusion in children.
  
  
  METHODS
  Data were searched in the Medline and Lilacs databases.
  
  
  RESULTS
  Complicated parapneumonic effusion should be surgically drained if thoracentesis reveals the presence of pus, positive Gram stain or culture, or pH less than 7.0 or glucose less than 40 mg/dl. The surgical drainage depends on the stage of parapneumonic pleural effusion: at the acute stage closed thoracostomy drainage is enough; at the fibrinopurulent stage thoracoscopy is indicated; at organizational stage thoracotomy can be performed in children with stable anesthetic conditions, and open thoracostomy drainage should be used in patients in a poor state of health. Echography is very important to evaluate the staging of parapneumonic effusion.
  
  
  CONCLUSIONS
  Surgical treatment of complicated parapneumonic effusion should be done as early as possible, and the kind of procedure depends on the stage of pleural effusion. In children with complicated parapneumonic effusion echography is very important to evaluate the staging of parapneumonic effusion.
authors.affiliation: Cirurgia Pediátrica, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS. jcfraga@brturbo.com
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Fraga
authors.forename: Peter
authors.initials: P
authors.lastname: Kim