• Farhan Ahmad Majeed, Sohail Saqib Chatha, Usama Zafar, Umar Farooq Chatha, Abdullah Zakaullah Chatha, and Zain Farooq.
• Department of Thoracic Surgery, Combined Military Hospital, Multan, Pakistan.
• J Coll Physicians Surg Pak. 2020 Mar 1; 30 (3): 309-312.

ObjectiveTo compare the effectiveness of open thoracotomy and video assisted thoracic surgery (VATS) for empyema thoracis in paediatric population.Study DesignObservational study.Place And Duration Of StudyThis observational study was conducted at Department of Thoracic Surgery, CMH, Lahore, from October 2013 to August 2018.MethodologyMedical record of children up to the age of 14 years who were operated for empyema thoracis was reviewed. Patients were divided into two groups: Open thoracotomy, and VATS; and compared for etiology, preoperative treatment, grade of empyema, procedure performed; histopathology and complications, e.g. post-thoracotomy neuralgia, surgical site infection, recurrence over 6 months.ResultsA total of 61 paediatric patients were operated for empyema thoracis. Age ranged between 1 to 14 years (mean = 10.25 ±3.30 years). Most common etiology of empyema was tuberculosis in 24 (39.3%) cases, followed by pneumonia in 22 (36.1%). Surgical treatment consisted of open thoracotomy in 40 (65.5%) cases, while 21 (34.5%) underwent VATS. Postoperative X-ray was satisfactory in 38 (95%) cases undergoing open thoracotomy as compared to 21 (100%) cases undergoing VATS (p=value 0.29). There was no recurrence in either of the two groups over a follow-up period of six months. Overall complication rate was 32.5% (13 cases) in cases undergoing open thoracotomy, while 33.3% (7 cases) in VATS group (p=value 0.95). There was one (2.5%) mortality in open thoracotomy group, while no death occurred in VATS group.ConclusionEarly surgical treatment, both open as well as VATS, gives satisfactory results in management of paediatric empyema. VATS is a safe alternative to open thoractomy with good success rate and less incidence of complications.

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