Position paper on video-assisted thoracoscopic surgery as treatment of pediatric empyema

  • Evan R. Kokoska
    Cincinnati Children's Hospital Medical Center, Peyton Manning Children's Hospital, Indianapolis, IN 46260, USA
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  • Mike K. Chen
    Corresponding author. Tel.: +1 352 392 3718.
    Department of Surgery, University of Florida College of Medicine, PO Box 100286, Gainesville, FL 32610, USA
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  • The New Technology Committee
    Author Footnotes
    1 Members of the New Technology Committee: Douglas Barnhart, MD; Mark Brown, MD; Casey Calkins, MD; Kenneth Gow, MD; Carroll Harmon, MD; Andre Hebra, MD; Timothy Kane, MD; David Lawlor, MD; Richard Pearl, MD; Thomas Tracy, MD.
  • Author Footnotes
    1 Members of the New Technology Committee: Douglas Barnhart, MD; Mark Brown, MD; Casey Calkins, MD; Kenneth Gow, MD; Carroll Harmon, MD; Andre Hebra, MD; Timothy Kane, MD; David Lawlor, MD; Richard Pearl, MD; Thomas Tracy, MD.


      Pediatric empyema can be managed with a variety of modalities, and the evidence for an ideal management strategy is limited. Early or simple effusions can be treated with antibiotics alone or with drainage when respiratory distress occurs. Once fibrinopurulent empyema has developed, therapy may involve either chest tube placement with instillation of fibrinolytics or video-assisted thoracoscopic surgery with pleural decortication. In late or fibrotic empyema, an assumption persists that the fibrotic peel must be managed by decortication that can be done either thoracoscopically or through a minithoracotomy incision.
      This position paper is coauthored by the New Technology Committee of the American Pediatric Surgery Association. The goal is to discuss the ongoing controversies and summarize, in an evidence-based manner, the various treatment options and to suggest a reasonable therapeutic algorithm for the care of children with empyema.

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