Comparative Outcomes of Video-Assisted Thoracoscopic Surgery (VATS) Versus Open Thoracotomy in the Management of Pediatric Empyema Thoracis

Abstract

Background: Empyema thoracis is a serious complication of pneumonia in children which often need surgical intervention. There are two types of process for decortication known as video-assisted thoracoscopic surgery (VATS) and open thoracotomy. The choice of use between these two remains debated due to differences in recovery, complications and outcomes. Objective: To compare the effectiveness of open thoracotomy and video assisted thoracic surgery (VATS) for empyema thoracis in pediatric population. Methodology: The present study was conducted at Combined Military Hospital Peshawar from August 2021 to August 2022. A total of 76 children with confirmed empyema thoracis, aged 1 to 14 years, who had either performed VATS or open thoracotomy were include in this study. Specialized proforma was prepared for data collection purposes.  Data was analyzed by SPSS v20.0. Results: Of the 76 patients, 42 had an open thoracotomy and 34 had VATS. Results showed that patients operated through VATS was linked to a significantly shorter hospital stay, chest tube duration, operative time, and return to normal activities (p < 0.001). Long-term results such as lung re-expansion, residual pleural thickening, and re-intervention rates were similar for both groups. In 5.8% of cases, open surgery was substituted for VATS. Conclusion: For initial-stage pediatric empyema, VATS is a minimal-invasive and effective surgery method yielding great perioperative outcomes without compromising long-term effectiveness. In more complex or advanced presentations, open thoracotomy remains required. Disease-staged and region-patterned tailored surgical methods, especially with tuberculosis, are essential for best management.