Published: 2020-05-26

Video assisted thoracoscopic surgery in the management of acute fibrinopurulent empyema in paediatric patients

Arti S. Mitra, Nilesh G. Nagdeve, Simran R. Khatri, Unmed A. Chandak


Background: Empyema is the presence of pus in the pleural space that usually follows an episode of pneumonia in pediatric age group. The aim of this study was to assess the efficacy of management of acute fibrinopurulent stage of empyema by early video assisted thoracoscopic surgery (VATS) in paediatric patients.

Methods: The study was carried out at a tertiary care hospital in India. It was a prospective interventional observational study. The study included 40 children between age group 0-12 years attending the surgery in-patient department referred for further management of parapneumonic effusions who had clinical and radiological evidence of empyema and thoracocentesis confirmed purulent exudate in pleural cavity, were subjected to early VATS after thorough pre-operative workup.

Results: The mean age was 7.22 years. Average operative time was 135.5 minutes. The mean duration of hospital stay was 7.5 days. Few complications were bleeding, superficial wound infection, bronchopleural fistula, pneumothorax, recurrence of empyema and incomplete expansion of lung.

Conclusions: VATS facilitates the management of fibrinopurulent and organised pyogenic pleural empyema with less post-operative discomfort and complications and reduced hospital stay. However larger sample size study is required to come to a definitive conclusion.


Empyema, Hospital stay, Paediatric, VATS

Full Text:



Menon P, Kanojia RP, Rao KLN. Empyema thoracis: surgical management in children. J Indian Asso Pedia Surg. 2009;14(3):85-93.

Gocmen A, Kiper N, Toppare M, Ozcelik U, Cengizlier R, Cetinkaya F. Conservative treatment of empyema in children. Respiration. 1993;60:182-5.

Satish B, Bunker M, Seddon P. Management of thoracic empyema in childhood: does the pleural thickening matter? Arch Dis Child. 2003;88:918-21.

Coote N, Kay E. Surgical versus non-surgical management of pleural empyema. Cochrane Database Syst Rev. 2005;4:CD001956.

Aydogan M, Aydogan A, Ozcan A, Tugay M, Gokalp AS, Arisoy ES. Intrapleural streptokinase treatment in children with empyema. Eur J Pediatr. 2008;167:739-44.

Fuller MK, Helmrath MA. Thoracic empyema, application of video-assisted thoracic surgery and its current management. Curr Opin Pediatr. 2007;19:328-32.

Cobanoglu U, Sayir F, Bilici S, Melek M. Comparison of the methods of fibrinolysis by tube thoracostomy and thoracoscopic decortication in children with stage II and III empyema: a prospective randomized study. Pediatr Rep. 2011;3(4):29.

Sonnappa S, Cohen G, Owens CM. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med. 2006;174:221-7.

Hazarika D, Deka R, Barman N, Duwarah H, Khyriem S, Saikia A, et al. Empyema thoracis: analysis of 150 cases from a tertiary care centre in north east India. Indian J Pediatr. 2011;78:1371-7.

Arya LS, Khalqyi AZ, Fazel MI. A study of empyema thoracis in children. Ind Pediatr. 1982;19:917-21.