Experience with video-assisted thoracoscopic surgery in the management of complicated pneumonia in children☆
Section snippets
Materials and methods
Thirty-nine consultations to the paediatric surgical service for intervention in empyema after failure of medical treatment were received during the period from November 1997 to October 1999. All these immunocompetent children had community-acquired pneumonia. All children had received appropriate intravenous antibiotics with or without thoracentesis. Surgical intervention was undertaken based on lack of clinical improvement or evidence of loculation, determined by computed tomography or
Results
The preoperative time, number of lung resections, need for blood transfusion secondary to intraoperative blood loss, analgesia requirements, time to become normothermic, duration of tube insertion, and postoperative length of stay in hospital for both groups are compared in Table 1.Empty Cell O V P Value Number 17 22 — Stage* 5:12 18:4 .003 Age (yr) 5.3 ± 0.64 4.9 ± 0.45 .86 Sex (M:F) 11:6 14:8 — Preoperative (d)† 13.64 ± 1.1 5.27 ± 0.41 <.0001 Lung Resection‡ 8 2†† .03
Discussion
Recently, there is a worldwide, although grossly underreported, increase in the number of loculated empyema resistant to conservative management.1, 6 Our hospital is the major tertiary referral centre for children in Southeast Asia, and we see approximately 30 cases of complicated pneumonia with empyema in children every year, in whom two thirds need surgical intervention (unpublished data). Before October 1998 when VATS was introduced in the surgical arm, all such cases were treated with open
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Cited by (56)
Surgical Management of Complicated Necrotizing Pneumonia in Children
2017, Pediatrics and NeonatologyCitation Excerpt :The optimal surgical treatment for acute NP with empyema remains controversial. Some investigators recommend formal LB for most cases,3,4,8,11 whereas others suggest that LB is rarely necessary and prefer to perform DC to preserve lung parenchyma.12,13 Because the severity of NP is considerably influenced by the degree of necrosis, the treatment should be based on the severity of destruction and any associated complications.
Pediatric empyema: Outcome analysis of thoracoscopic management
2009, Journal of Thoracic and Cardiovascular SurgeryEfficacy of video-assisted thoracoscopic surgery in managing childhood empyema: a large single-centre study
2009, Journal of Pediatric SurgeryCitation Excerpt :Several studies have evaluated VATS as a treatment modality for childhood empyema and they are summarised in Table 4. A nonrandomised study compared VATS with thoracotomy and the authors favoured VATS on the basis of reduced hospital stay, duration of postoperative antibiotics and chest drain requirements [26]. There are 2 randomised controlled trials evaluating the role of VATS in childhood empyema.
Pediatric parapneumonic pleural effusions: Experience in a university central hospital
2009, Revista Portuguesa de PneumologiaCommunity-acquired parapneumonic effusion in children: what's new?
2007, Archives de PediatrieVideo-Assisted thoracoscopic surgery for pediatric empyema by two-port technique: A single-center experience with 167 consecutive cases
2017, Journal of Indian Association of Pediatric Surgeons
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Address reprint requests to Ramnath Subramaniam, Associate Consultant, Department of Paediatric Surgery, K.K. Women and Children's Hospital, 100, Bukit Timah Rd, Singapore 229899.