Thoracoscopic decortication in infants and children

Background: The treatment of pediatric empyemas remains controversial. While thoracentesis and tube thoracostomy appear adequate for relatively benign organisms, virulent bacteria cause thick fibrinous pleural peels entrapping the lung. Open thoracotomies have been effectively used for decortication but are painful. Methods: We report the use of minimally invasive thoracoscopic decortication in 12 patients (mean age 5 years). All failed conventional management with persistent fever, increasing oxygen requirement, recurrent effusion, and pleural consolidation; 5- and 10-mm trocars were used and complete decortication was accomplished. Results: Ten of 12 patients were afebrile by 72 h and discharged 4–12 days after surgery. Eleven of 12 patients had clear chest x-rays by 1 month. Conclusion: Thoracoscopic decortication is a safe and effective means of treating pediatric empyemas. Received: 25 March 1996/Accepted: 28 May 1996