Video-assisted thoracoscopic surgery of childhood empyema: early referral improves outcome

Video-assisted thoracoscopic surgery (VATS) is considered a safe and effective option in the treatment of childhood empyema. The aim of this study was to assess the efficacy of early referral for primary VATS in childhood empyema. A cohort of 24 consecutive children (12 boys, 12 girls) from 2004 to 2009 with post-pneumonic empyema, as demonstrated by loculation on ultrasound, undergoing VATS at a single tertiary level institution, was reviewed. All cases of empyema were managed as per the local protocol of early referral for primary VATS. Mean age of presentation was 54 months (5 months to 15 years). Mean duration of symptoms before presentation to our centre was 6.29 days (+/- 2.74 days) (range 1-10 days) and mean time to referral to the paediatric surgical unit was 1.95 days (+/- 2.57 days). VATS was performed in all patients with a mean operating time 113.7 min (+/- 37.0 min), which included time for bronchoscopy (range 43-184 min). The mean duration of chest drainage was 4 days (+/- 2.96 days) and post-operative hospitalisation was 6.88 days (+/- 4.11 days). Early primary VATS for post-pneumonic empyema in children demonstrated a higher success rate, lower conversion to open thoracotomy improved outcome and shorter hospitalisation.