Primary Thoracoscopic Drainage of Fibro Purulent Stage Empyema in Children Versus Conventional Chest Tube Drainage as Regard Time of Hospital Stay and Need for Further Surgical Intervention in Form of Open Decortication

Background: Empyema is a common purulent complication of bacterial pneumonia in children. The condition progresses through three stages: Exudative, fibro purulent, and organizational. Empyema complicates 0.6% to 2% of pediatric pneumonia cases. Treatment strategies for pediatric para-pneumonic effusions and empyema remain controversial, with significant variations in approaches.
Objective: This study aimed to evaluate the effectiveness of primary thoracoscopic drainage of fibro purulent stage empyema in children in decreasing the hospital stay and the need for further decortication compared to the conventional chest tube drainage.
Methods: A prospective study was conducted on 100 pediatric patients (ages 1.2 to 12 years) with empyema admitted to Sohag University Hospital from March 2018 to April 2022. Fifty patients underwent conventional chest tube drainage with antibiotic therapy, while fifty patients received primary thoracoscopic drainage under general anesthesia. Data collected included hospital stay, chest tube duration, and need for further interventions like open decortication.
Results: Both groups were found to have fibro-purulent empyema at the time of surgery. The thoracoscopic group had significantly shorter hospital stays (7.4 ± 0.3 days vs. 20.6 ± 6.3 days) and chest tube drainage durations (3.0 ± 0.5 days vs. 12.2 ± 6.1 days) compared to the conventional group (P < 0.001). Additionally, the thoracoscopic group had a significantly lower incidence of open decortication (4% vs. 30%, P < 0.001).
Conclusion: Thoracoscopic drainage significantly reduced hospital stay, the duration of chest tube drainage, and the need for secondary surgical interventions in pediatric empyema. These results suggest that thoracoscopy should be considered a first-line treatment for advanced or loculated para-pneumonic effusions in children, especially in regions with limited postoperative care adherence.