gms | German Medical Science

128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

VATS best in empyema? Review on literature and evaluation of a treatment-algorithm in a tertiary centre

Meeting Abstract

  • Andreas Bartenstein - Inselspital, Universitätsspital Bern, Kinderchirurgie, Bern
  • P. Agyemann - Inselspital, Universitätsspital Bern, Kinderchirurgie, Bern
  • C. Aebi - Inselspital, Universitätsspital Bern, Kinderchirurgie, Bern
  • D. Cholewa - Inselspital, Universitätsspital Bern, Kinderchirurgie, Bern

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch147

DOI: 10.3205/11dgch147, URN: urn:nbn:de:0183-11dgch1471

Published: May 20, 2011

© 2011 Bartenstein et al.
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Outline

Text

Introduction: The treatment of pleural empyema in children remains controversial. VATS (video assisted thoracoscopic surgery) and pleural drainage combined with fibrinolysis are up to now the two most established procedures. Large prospective and randomised trials to achieve a high level evidence for the treatment of choice (operative versus non-operative) are still rare.

Materials and methods: In a tertiary institution with paediatrics and paediatric surgery we implemented an algorithm to guide decisions in daily routine on diagnostics and therapy depending on the stage of the disease. For the purpose of internal quality control we evaluated our data retrospectively over the past 5 years. Since the latest literature tends to a non-invasive approach we also focused on drainage with fibrinolysis. Besides the primary outcome measures length of hospital stay, duration of drainage, complications associated to therapy also microbiological aspects were investigated. We were interested to see if there is a link between the different pathogens or serovars of streptococcus pneumoniae and the severity of the disease course.

Results: 63 of 225 (28%) patients with parapneumonic effusion underwent pleural fluid drainage. Initial procedures included pleural tapping (n=9, 14%), chest tube drainage (n=20, 32%), fibrinolysis (n=10, 16%), VATS (n=23, 37%), thoracotomy (n=1, 1%). The median LOS was 14 days for pleural tapping, drainage and VATS within 48h, 16 days for VATS later than 48h. Duration of chest tube drainage had no significant difference in both groups with a median of 5 days. Secondary surgical interventions are significantly higher after pleural tapping and drainage. Streptococcus pyogenes and pneumoniae are the main pathogens. Serovars not included in pneumococcal vaccination were frequent. A negative proof of pathogens is associated with fewer days of drainage and hospitalisation.

Conclusion: Our conclusion is, that empyema in children needs an early starting therapy, that must be appropriate to the stage of the disease and should be the definitive treatment to reduce morbidity, length of hospital stay and associated complications. Microbiologic results are valuable as a prognostic factor.