title: [Significance of Thoracic Surgery for Treatment of Pleural Empyema in Childhood and Adolescence].
abstract: BACKGROUND
  There still is controversy about surgical treatment of pleural empyema in children.
  
  
  METHODS
  Retrospective analysis of treatment strategy, focussing on indication for surgery and outcome of children treated in 2 centres for pleural complications due to primary pneumonia from January 1(st) 2008 to December 31(st) 2012. RESULTS were compared to studies published within the last 10 years.
  
  
  RESULTS
  1 451 children with pneumonia were treated during the 5 year period. 187 (average age 6.1 years, sex: 86/101 f/m) developed a pleural effusion.
  
  
  METHODS
  pleural punction in 22 children, chest tube in 78 and operation in 37 children. In 9 cases microorganisms were identified. 34 children were operated for empyema stage II, only 3 for stage III. 3 children were operated due to septicaemia not responding to antibiotics. Time from admission to operation (including referring hospital):14.5 days. Time from operation to discharge: 12,5 days. All children but one were operated by thoracoscopy.
  
  
  RESULTS
  1 bronchopleural fistula, 1 delayed healing of the wound. All children survived and fully recovered mean (observation period 28 months postoperatively).
  
  
  CONCLUSIONS
  In experienced hands thoracic surgery yields excellent results for children suffering from pleural empyema stage II and III. Recent randomised prospective trials comparing fibrinolysis with VATS do not convince regarding the treatment protocols of their surgical arms. Fibrinolysis is nevertheless a valuable treatment in early stage II empyema, especially if thoracic surgical experience is not available. However, the further advanced the empyema presents, the sooner surgical experience should be gathered.
authors.affiliation: HELIOS Klinikum Krefeld, Department of Thoracic Surgery, Krefeld.
authors.forename: V
authors.initials: V
authors.lastname: Haas
authors.affiliation: HELIOS Klinikum Krefeld, Department of Thoracic Surgery, Krefeld.
authors.forename: R
authors.initials: R
authors.lastname: Bayerstorfer
authors.affiliation: HELIOS Klinikum Krefeld, Department of Thoracic Surgery, Krefeld.
authors.forename: O
authors.initials: O
authors.lastname: Kuhtin
authors.affiliation: HELIOS Klinikum Krefeld, Department of Thoracic Surgery, Krefeld.
authors.forename: T
authors.initials: T
authors.lastname: Bulgan
authors.affiliation: HELIOS Klinikum Krefeld, Department of Thoracic Surgery, Krefeld.
authors.forename: M
authors.initials: M
authors.lastname: Hohls
authors.affiliation: Department of Thoracic Surgery, University Hospital Ekaterinburg, Ekaterinburg, Russian Federation.
authors.forename: N
authors.initials: N
authors.lastname: Zap
authors.affiliation: Department of Thoracic Surgery, University Hospital Ekaterinburg, Ekaterinburg, Russian Federation.
authors.forename: I
authors.initials: I
authors.lastname: Vinogradova
authors.affiliation: Department of Thoracic Surgery, University Hospital Ekaterinburg, Ekaterinburg, Russian Federation.
authors.forename: E
authors.initials: E
authors.lastname: Nekrasova
authors.affiliation: HELIOS Klinikum Krefeld, Centre for Paediatric Medicine and Centre for Child and Adolescent Health, Krefeld.
authors.forename: S
authors.initials: S
authors.lastname: Shai
authors.affiliation: HELIOS Klinikum Krefeld, Centre for Paediatric Medicine and Centre for Child and Adolescent Health, Krefeld.
authors.forename: I
authors.initials: I
authors.lastname: Heesen
authors.affiliation: HELIOS Klinikum Krefeld, Centre for Paediatric Medicine and Centre for Child and Adolescent Health, Krefeld.
authors.forename: P
authors.initials: P
authors.lastname: Heister
authors.affiliation: HELIOS Klinikum Krefeld, Centre for Paediatric Medicine and Centre for Child and Adolescent Health, Krefeld.
authors.forename: C
authors.initials: C
authors.lastname: Andrée
authors.affiliation: HELIOS Klinikum Krefeld, Centre for Paediatric Medicine and Centre for Child and Adolescent Health, Krefeld.
authors.forename: T
authors.initials: T
authors.lastname: Niehues
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D007902:Length of Stay; D008169:Lung Abscess / Q000601:surgery; D008297:Male; D011014:Pneumonia / Q000150:complications; D011183:Postoperative Complications / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted