# Role of Video-Assisted Thoracoscopic Surgery in Acute Empyema in Children: A Retrospective Analysis

## TL;DR

This study shows that video-assisted thoracoscopic surgery is a safe and effective treatment for advanced empyema in children.

## Contribution

The paper provides evidence supporting VATS as the primary surgical approach for Stage II and III pediatric empyema.

## Key findings

- VATS was successful in 86.4% of patients with Stage II and III empyema.
- All patients showed complete radiological resolution at three months with no recurrence.
- Postoperative complications were minimal, with fever being the most common.

## Abstract

Background

Acute empyema is a serious complication of paediatric pneumonia that often necessitates surgical intervention in advanced stages. Video-assisted thoracoscopic surgery (VATS) has emerged as one of the commonly used modalities of surgical management of empyema, due to its minimally invasive nature and favorable outcomes. The study aims to evaluate the efficacy and outcomes of VATS in the management of Stage II and III acute empyema in children at a single tertiary care center.

Methods

This retrospective study analyzed 22 paediatric patients with radiologically confirmed Stage II or III empyema who underwent VATS between January 2022 and March 2025. Preoperative characteristics, intraoperative findings, postoperative complications, and follow-up outcomes were assessed with appropriate statistical methods.

Results

Among 22 patients, the majority (n=15, 68.2%) had right-sided empyema. Common symptoms included fever in all the patients (100%) and cough in 19 (86.4%), with a mean symptom duration of 14.5 days. Preoperative intercostal drain (ICD) insertion was performed in 13 (59.1%) cases. VATS was successful in 19 (86.4%) patients, while three (13.6%) required conversion to thoracotomy. The mean operative time was 96.1 minutes, and the average blood loss was 60.2 mL. Postoperatively, 10 (45.5%) experienced fever, and two (9.1%) had air leaks. At the three-month follow-up, all patients showed complete radiological resolution with no residual or recurrent empyema.

Conclusion

VATS is a safe and effective surgical option for paediatric empyema unresponsive to medical therapy. Early intervention is associated with favorable recovery, minimal complications, and excellent long-term outcomes. VATS should be considered the primary surgical approach for Stage II and III empyema in children.