Comparative study between outcome of intercostal tube drainage and video assisted thoracoscopic surgery in management of complicated parapneumonic effusion in children

Background

Intercostal tube drainage (ICTD) has been known for the management of complicated parapneumonic effusion (PPE) since the early 1870s. Video assisted thoracoscopic surgery (VATS) has been applied since the early 1990s. The aim of this study was to compare between both surgical procedures in children.

Methods

This randomized clinical study included 75 children for drainage of complicated PPE in the Cardiothoracic Surgery Department of Alexandria University hospital, Egypt. They were classified into two groups. Group I included 35 children managed by ICTD while group II included 40 children managed by VATS.

Results

The mean age in group I was 7.81 ± 4.04 years and 8.93 ± 1.73 years in group II. Mean duration on medical therapy before and after intervention was 0.74 ± 2.83 days in group I and 4.80 ± 0.94 days in group II, and 11.06 ± 5.31 days in group I, and 2.88 ± 1.52 days in group II respectively. Success rate following primary intervention was 17.1% in group I and 90% in group II. Average amount of pleural fluid drained was 291.14 ± 94.86 ml in group I and 156.50 ± 76.28 ml in group II.

The mean hospital stay following primary intervention was 11.06 days in the first group and 2.43 days in group II. The mean hospital stay after secondary intervention in group I was 3.74 ± 2.79. In contrast, it was 1.38 days in group II which was significantly shorter than that of the group I. Moreover, the mean total hospital stay was 14.77 ± 7.12 days in the first group and 7.68 ± 2.07 days in the second group.

Conclusions

VATS is a safe and effective procedure with low rates of complications. Early VATS should be the first treatment of choice in children with PPE.