Comparing the efficacy of video assisted thoracoscopic surgery (VATS) vs intrapleural fibrinolytic therapy in children with pleural empyema

Abstract

Purpose To compare the effects of video-assisted thoracoscopic surgery (VATS) and fibrinolytic injection into the pleural space in children with empyema. Methods This randomized clinical trial included 51 children with empyema, who were divided into two groups. In the first group (25 patients), VATS was performed, while in the second group (26 patients), 0.1 mg/kg of Reteplase was injected into the pleural space for 3 days. The length of hospitalization, pediatric intensive care unit (PICU) stay, duration of fever and dyspnea, duration of antibiotic administration, duration of chest tube presence, and the need for reoperation were compared between the groups. Results In the Reteplase injection and VATS groups, the mean duration of hospitalization was 21.1 +/- 7.5 and 12.3 +/- 6 days (P < 0.001), respectively, and the length of PICU stay was 7.8 +/- 3.8 and 1.9 +/- 2.3 days (P < 0.001), respectively. The duration of antibiotic administration was significantly longer in the Reteplase group. The chest tubes were present for a longer duration in the Reteplase group, and the duration of fever was also significantly longer. Conclusion VATS surgery in children with empyema is associated with more favorable clinical outcomes compared to fibrinolytic therapy with Reteplase.