WOFAPS 2025 8th World Congress of Pediatric Surgery

Carolina Soares-Aquino, Silviana Ribeiro, Sofia Vasconcelos-Castro, Norberto Estevinho, Miguel Campos, Mariana Borges-Dias

Department of Pediatric Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal

Purpose

Parapneumonic pleural empyema (PPE) is common in children, however, the most appropriate treatment is not yet well established in literature. Our aim was to analyse and compare the cases of PPE in our institution, in order to guide the most appropriate treatment.

Method

Retrospective analysis of the cases of PPE from 2012-2024. Collected data: demographics, time from diagnosis to treatment, failure, alternative treatments, treatment duration, complications and follow-up. Lung necrosis contraindicated intrapleural fibrinolysis. Simple effusion and bilateral pneumonia were excluded. The time until treatment was considered only after diagnosis of PPE. Statistical significance was established as 0.05.

Results

We identified 77 cases, with a median age of 5 years. 39% were females. Initial treatment was: simple drainage (D) in 13%; intrapleural fibrinolysis (F) in 58%; and thoracoscopic decortication (T) in 29%. Failure happened on 10/10 submitted to D; 10/45 submitted to F; 2/22 submitted to T. Alternative treatment was F in 23%; T in 64%; and classic decortication in 14%. There was no difference between F and T in terms of failure (p=0.310), however, treatment time was superior in F (17 versus 13 days, p=0.004). Excluding the cases of failure, there was no difference between F and T in terms of treatment time, postoperative fever and complications. Median follow-up was 6 months.

Conclusion

According to our data, while simple drainage of parapneumonic pleural empyema should not be attempted, both thoracoscopic decortication and fibrinolysis are appropriate treatments, without a difference in failure rates; however, there was a shorter treatment time in thoracoscopic decortication when compared to fibrinolysis. Both treatments are effective and safe, but thoracoscopic decortication should be employed straight away in cases when fibrinolysis is contraindicated, as in necrotizing pneumonia, as there was no increase in complication rate.