title: Thoracoscopy in the treatment of pleural empyema in pediatric patients.
abstract: OBJECTIVE
  To evaluate the results of thoracoscopy for the treatment of pleural empyema in pediatric patients.
  
  
  METHODS
  A retrospective study of 117 patients who underwent mediastinoscopy or video-assisted thoracoscopy for pleural empyema treatment. General anesthesia and single-lumen oral intubation were used. Surgery was indicated when there was pleural effusion and no clinical and radiological response to clinical treatment (antibiotics, physiotherapy and thoracocentesis) or severe sepsis, together with loculated pleural effusion (confirmed through ultrasound or computed tomography of the chest).
  
  
  RESULTS
  Between February of 1983 and July of 2006, 117 thoracoscopies were performed in patients ranging in age from 5 months to 17 years (mean, 4 years). Mean time for thoracic drainage was 9 days (range, 2-33 days), and mean period of hospitalization was 16.4 days (range, 4 to 49 days). One patient (0.8%) died after surgery, and persistent fistula was observed in 33 patients (28%). In 7 cases (6%), open thoracotomy with pulmonary decortication was performed due to the disposition of the empyema.
  
  
  CONCLUSIONS
  Management of pleural empyema in this age bracket is still controversial, and surgical indication is often delayed, particularly when there are multiple loculations or severe sepsis. Early thoracoscopy yields a better clinical outcome for pediatric patients with pleural empyema, with apparent decreased morbidity and mortality, earlier chest tube removal, earlier hospital discharge and improved response to antibiotic therapy.
authors.affiliation: Hospital Israelita Albert Einstein, Hospital Jaraguá, São Paulo, Brazil. daviwwkang@ig.com.br
authors.forename: Davi Wen Wei
authors.initials: DW
authors.lastname: Kang
authors.forename: José Ribas Milanez de
authors.initials: JR
authors.lastname: Campos
authors.forename: Laert de Oliveira
authors.initials: Lde O
authors.lastname: Andrade Filho
authors.forename: Fabiano Cataldi
authors.initials: FC
authors.lastname: Engel
authors.forename: Alexandre Martins
authors.initials: AM
authors.lastname: Xavier
authors.forename: Maurício
authors.initials: M
authors.lastname: Macedo
authors.forename: Karine
authors.initials: K
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome