Study objectives: Previous articles have promoted the
early use of thoracotomy and decortication for refractory empyema. This
study examines thoracoscopy and decortication at the time of initial
chest tube placement in pediatric patients with parapneumonic
Design: We reviewed the medical records of 16
consecutive patients who were children with parapneumonic empyema.
Results: Thirteen children (group 1) underwent
thoracoscopic decortication and tube thoracostomy as their initial
operative procedures; 3 children (group 2) had tube thoracostomy alone.
In both groups, chest tubes were removed prior to their discharge to
home. The mean (± SD) operative time for thoracoscopy was
81 ± 19 min with no complications. On average, chest tubes were
removed by postoperative day 4. The mean time to discharge was 8.3
days. Two children eventually required lobectomy. The mean operative
time for chest tube placement alone was 21 ± 3 min. Children
required chest tube drainage for an average of 12.3 days. The mean time
to discharge was 16.6 days. Two patients required a total of five
additional operative procedures, including two additional chest tube
placements, two open decortications, and one lobectomy.
Conclusions: Thoracoscopic decortication is effective in
the early treatment of pediatric parapneumonic empyema. It facilitates
visualization, evacuation, and mechanical decortication of the pleural
space with no additional morbidity and may lead to reduced time for
chest tube drainage, shorter hospitalization, and more rapid clinical