title: Efficacy of video-assisted thoracoscopic surgery in managing childhood empyema: a large single-centre study.
abstract: OBJECTIVE
  A randomised controlled trial evaluating the role of video-assisted thoracoscopic surgery (VATS) in childhood empyema reported a failure rate of 16.6%. Our aim is to determine the outcome of VATS in a large series of children managed by 3 paediatric surgeons experienced in endoscopic surgery.
  
  
  METHODS
  A retrospective study of all children with empyema admitted under the care of the 3 surgeons between February 2004 and February 2008 was undertaken. Recorded details included demographic data, mode of presentation, preoperative investigations, operative details, antibiotic usage, microbiological data, postoperative course, follow-up data and complications.
  
  
  RESULTS
  114 children (69 boys, 45 girls) had VATS for empyema. Their median age was 5 (0.2-15) years. The pleural cavity was drained for a median of 4 (2-13) days. Median postoperative hospital stay was 7 (4-36) days. Median follow-up was 8 (1-24) months. There were 8 (7%) treatment failures: 5 conversions to thoracotomy and 3 recurrent empyemas. There were 7 complications (6%): air leak (n = 6) and lung injury (n = 1). 104 (91%) children had full resolution of symptoms. There were no deaths.
  
  
  CONCLUSIONS
  Video-assisted thoracoscopic surgery has a better outcome in childhood empyema than reported in a recent randomised trial and it has an important role in the management of this condition.
authors.affiliation: Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Bishay
authors.forename: Melissa
authors.initials: M
authors.lastname: Short
authors.forename: Kant
authors.initials: K
authors.lastname: Shah
authors.forename: Shobhana
authors.initials: S
authors.lastname: Nagraj
authors.forename: Suren
authors.initials: S
authors.lastname: Arul
authors.forename: Dakshesh
authors.initials: D
authors.lastname: Parikh
authors.forename: Girish
authors.initials: G
authors.lastname: Jawaheer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted