Journal of Pediatric Surgery
Volume 44, Issue 1 , Pages 106-111 , January 2009

Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial

  • Shawn D. St. Peter

      Affiliations

    • Center for Prospective Clinical Trials, Department of Pediatric Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 816 983 6479; fax: +1 816 983 6885.
    • ,
  • Kuojen Tsao

      Affiliations

    • Center for Prospective Clinical Trials, Department of Pediatric Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
    • ,
  • Christopher Harrison

      Affiliations

    • Department of Infectious Disease, Children’s Mercy Hospital, Kansas City, MO 64108, USA
    • ,
  • Mary Ann Jackson

      Affiliations

    • Department of Infectious Disease, Children’s Mercy Hospital, Kansas City, MO 64108, USA
    • ,
  • Troy L. Spilde

      Affiliations

    • Center for Prospective Clinical Trials, Department of Pediatric Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
    • ,
  • Scott J. Keckler

      Affiliations

    • Center for Prospective Clinical Trials, Department of Pediatric Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
    • ,
  • Susan W. Sharp

      Affiliations

    • Center for Prospective Clinical Trials, Department of Pediatric Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
    • ,
  • Walter S. Andrews

      Affiliations

    • Center for Prospective Clinical Trials, Department of Pediatric Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
    • ,
  • George W. Holcomb III

      Affiliations

    • Center for Prospective Clinical Trials, Department of Pediatric Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
    • ,
  • Daniel J. Ostlie

      Affiliations

    • Center for Prospective Clinical Trials, Department of Pediatric Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA

Received 30 September 2008 ,Accepted 7 October 2008.

References 

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  2. Hope WW, Bolton WD, Stephenson JE. The utility and timing of surgical intervention for parapneumonic empyema in the era of video-assisted thoracoscopy. Am Surg. 2005;71:512–514
  3. Olgac G, Fazlioglu M, Kutlu CA. VATS decortication in patients with stage 3 empyema. Thorac Cardiovasc Surg. 2005;53:318–320
  4. Cheng G, Vintch JR. A retrospective analysis of the management of parapneumonic empyemas in a county teaching facility from 1992 to 2004. Chest. 2005;128:3284–3290
  5. Tsao K, St Peter SD, Sharp SW, et al. Current application of thoracoscopy in children. J Laparoendosc Adv Surg Tech A. 2008;18:131–135
  6. Coote N, Kay E, Coote N. Surgical versus non-surgical management of pleural empyema. Cochrane Database Syst Rev. 2005;CD001956:
  7. Kurt BA, Winterhalter KM, Connors RH, et al. Therapy of parapneumonic effusions in children: video assisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics. 2006;118:e547–e553
  8. Gates RL, Hogan M, Weinstein S, et al. Drainage, fibrinolytics, or surgery: a comparison of treatment options in pediatric empyema. J Pediatr Surg. 2004;39:1638–1642
  9. Yao CT, Wu JM, Liu CC, et al. Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children. Chest. 2004;125:566–571
  10. Ekingen G, Guvenc BH, Sozubir S, et al. Fibrinolytic treatment of complicated pediatric thoracic empyemas with intrapleural streptokinase. Eur J Cardiothorac Surg. 2004;26:503–507
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  14. Barbato A, Panizzolo C, Monciotti C, et al. Use of urokinase in childhood pleural empyema. Pediatr Pulmonol. 2003;35:50–55
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  17. Rosen H, Nadkarni V, Theroux M, et al. Intrapleural streptokinase as adjunctive treatment for persistent empyema in pediatric patients. Chest. 1993;103:1190–1193
  18. Cochran JB, Tecklenburg FW, Turner RB. Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema. Pediatr Crit Care Med. 2003;4:39–43
  19. Ulku R, Onat S, Kiliç N. Intrapleural fibrinolytic treatment of multiloculated pediatric empyemas. Minerva Pediatr. 2004;56:419–423
  20. Bouros D, Antoniou KM, Chalkiadakis G, et al. The role of video-assisted thoracoscopic surgery in the treatment of parapneumonic empyema after the failure of fibrinolytics. Surg Endosc. 2002;16:151–154
  21. Stringel G, Hartman AR. Intrapleural instillation of urokinase in the treatment of loculated pleural effusions in children. J Pediatr Surg. 1994;29:1539–1540
  22. Ozcelik C, Inci I, Nizam O, et al. Intrapleural fibrinolytic treatment of multiloculated postpneumonic pediatric empyemas. Ann Thorac Surg. 2003;76:1849–1853
  23. Thomson AH, Hull J, Kumar MR, et al. Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax. 2002;57:343–347
  24. Jaffe A, Balfour-Lynn IM. Management of empyema in children. Pediatr Pulmonol. 2005;40:148–156
  25. Doski JJ, Lou D, Hicks BA, et al. Management of parapneumonic collections in infants and children. J Pediatr Surg. 2000;35:265–268
  26. Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med. 2006;174:221–227

 Presented at the 39th annual meeting of the American Pediatric Surgical Association, Phoenix, AZ, May 27-June 1, 2008.

PII: S0022-3468(08)00872-5

doi: 10.1016/j.jpedsurg.2008.10.018

Journal of Pediatric Surgery
Volume 44, Issue 1 , Pages 106-111 , January 2009

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