title: Thoracoscopy in the management of pediatric empyemas.
abstract: BACKGROUND
  Thoracoscopy is increasingly being used in the treatment of empyema. This study assesses feasibility, efficacy and safety in children.
  
  
  METHODS
  Clinical files of patients who underwent primary thoracoscopy for empyema between 2006 and 2014 were reviewed. Demographic, clinical and surgical data were analyzed and a comparison between the period before (period1) and after (period2) the learning curve was performed.
  
  
  RESULTS
  Ninety-one patients (53 males, 58%) were submitted to thoracoscopy at a median age of 4 years. There were 19 conversions to thoracotomy with a steady decrease of conversion rate until 2009 (period1) and no conversions thereafter (period2). There was no difference in any of the analyzed parameters between patients submitted to thoracoscopy alone and those requiring conversion in period1. Six cases (6.6%) needed redo-operation (five in period2) and thoracotomy was the elected approach in four. Necrotizing pneumonia was present in 60% of the reoperated cases; in other words, in period2 3 out of 9 cases with necrotizing pneumonia required reintervention (p=0.07). Thoracotomy was avoided in sixty-eight (75%) patients (62% in period1 versus 92% in period2, p=0.001).
  
  
  CONCLUSIONS
  Thoracoscopic approach for empyema is feasible and safe avoiding a significant number of thoracotomies after a short learning curve. An increase of reintervention rate should be expected, but throracoscopy alone is effective in the great majority of the cases. Necrotizing pneumonia may be associated with a higher risk of reintervention, as it is a contra-indication to thoracoscopy and probably surgery.
authors.affiliation: Pediatric Surgery Department, Hospital São João, Faculty of Medicine, Porto, Portugal. Electronic address: rubenlms@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Lamas-Pinheiro
authors.affiliation: Pediatric Surgery Department, Hospital São João, Faculty of Medicine, Porto, Portugal.
authors.forename: T
authors.initials: T
authors.lastname: Henriques-Coelho
authors.affiliation: Pediatric Surgery Department, Hospital São João, Faculty of Medicine, Porto, Portugal; Pediatric Department, Hospital São João, Faculty of Medicine, Porto, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Fernandes
authors.affiliation: Pediatric Surgery Department, Hospital São João, Faculty of Medicine, Porto, Portugal; Pediatric Department, Centro Hospital do Alto Ave, Guimarães, Portugal.
authors.forename: F
authors.initials: F
authors.lastname: Correia
authors.affiliation: Pediatric Department, Hospital São João, Faculty of Medicine, Porto, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Ferraz
authors.affiliation: Pediatric Department, Hospital São João, Faculty of Medicine, Porto, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Guedes-Vaz
authors.affiliation: Pediatric Department, Hospital São João, Faculty of Medicine, Porto, Portugal.
authors.forename: I
authors.initials: I
authors.lastname: Azevedo
authors.affiliation: Pediatric Surgery Department, Hospital São João, Faculty of Medicine, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Estevão-Costa
mesh_terms: D002675:Child, Preschool; D016724:Empyema, Pleural / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013906:Thoracoscopy; D016896:Treatment Outcome
keywords: Children; Conversion; Empyema; Reintervention; Thoracoscopy