PURPOSE: The purpose of this study is to compare treatment of empyema with primary chest tube thoracostomy (TUBE) to primary VATS for debridement and drainage to determine whether any of the methods is superior in terms of therapeutic evolution in our hospital.
METHODS: This study included all children with empyema who received inpatient care in a university hospital over the past four years. Data collected included information on age, gender, presenting symptoms, duration of symptoms, previous use of antibiotics, biochemical analysis of the fluid, organisms identified in the fluid, management modality adopted (TUBE or VATS), residence time of pleural drain, complications, need for re-intervention, and late radiologic evolution up to 4 months after hospital discharge.
RESULTS: A total of 53 patients were assessed. Of these, 31 were treated with TUBE and 22 with VATS. Age ranged from seven months to 14 years. The male gender slightly prevailed in 55% of the cases. Duration of symptoms ranged from one to 30 days, and did not differ between groups. The mean values of pH was 6,9, DHL 4062 and glucose 46. Bacterioscopy and/or cultures were positive in 22.6% of the cases, with streptococos pneumoniae predominance in both groups. Residence time of pleural drain varied from two to 23 days and there was a significant difference between groups. In the VATS group, the mean was four days, whereas in the TUBE group it was 10 days. In six patients of the TUBE group (19%), decortication was necessary. Drain replacement was needed by 8 patients treated with TUBE (25%). Only one patient with a drain placed after VATS (9%) required replacement and none need re-intervention. Radiologic evolution over the first two months after discharge was slightly improved in the VATS group, and reached normality in both groups after four months.
CONCLUSION: VATS was more effective than TUBE in the treatment of empyema.
CLINICAL IMPLICATIONS: With VATS, residence time of pleural drain was shorter and no re-intervention was required resulting in early recovery and discharge.
DISCLOSURE: Daniele Cataneo, No Financial Disclosure Information; No Product/Research Disclosure Information