Balloon-assisted single-port thoracoscopic debridement in children with thoracic empyema.

Abstract

PURPOSE:

In this study, we evaluated the results of a balloon-aided single-port thoracoscopic debridement of late-stage thoracic empyema in children.

PATIENTS AND METHODS:

We retrospectively reviewed age, gender, duration of prehospital illness, physical findings, surgical interventions, and the morbidity in 12 children with late-stage parapneumonic empyema. The diagnosis of pleural effusion was confirmed by a thoracocentesis before thoracoscopy. A balloon connected to a 12 F feeding tube was inserted into the thoracic cavity and inflated with air before the enterance of the thoracoscope. By this maneuver, a cavity was formed just under the enterance point. Thereafter, a routine debridement and chest irrigation was performed by thoracoscopy. Only one port was inserted in all but 1 patient, and the telescope was used as a dissecting tool. A thorax tube was inserted through the port site at the end of the procedure and left for the drainage.

RESULTS:

The main symptoms of the patients were dyspnea, cough, and fever. The empyema was located on the right hemithorax in 5 patients and on the left side in 7 patients. A second port was necessary to enhance the dissection in 1 case. The chest tube was removed within 3-30 days (median, 11 days) after the surgical approach. No complication directly related to the procedure was seen. The only problems postoperatively were a self-limited and spontaneously resolved bronchopleural fistula in 4 patients, and we had to perform an additional thoracoscopy to resolve the remaining intrapleural adhesions in 1 child.

CONCLUSIONS:

Thoracoscopic debridement in patients with late-stage thoracic empyema may be very beneficial, and this treatment method may provide any further thoracotomy. A balloon inflated in the thoracic cavity may achieve a wider field of vision for thorascopic surgery, and single-port thoracoscopy is sufficient and safe for the dissection.

• Authors: Burak Tander, Levent Ustun, Ender Ariturk, Riza Rizalar, Suat H Ayyildiz, Ferit Bernay
• Journal: Journal of laparoendoscopic & advanced surgical techniques. Part A (J Laparoendosc Adv Surg Tech A) Vol. 17 Issue 4 Pg. 504-8 (Aug 2007) ISSN: 1092-6429 [Print] United States
• PMID: 17705737 (Publication Type: Journal Article)

Topics

• Adolescent
• Catheterization
• Child
• Child, Preschool
• Debridement (methods)
• Empyema, Pleural (surgery)
• Female
• Humans
• Infant
• Male
• Retrospective Studies
• Therapeutic Irrigation
• Thoracic Surgery, Video-Assisted (methods)