Arjun Saxena, Abhishek Tiwari


Aim: The management of empyema depends upon the stage of the disease. Video-assisted thoracoscopic surgery (VATS) can be done in intermediate fibrinopurulant stage, but difficult in organized stage. We evaluated the importance of early referral to the higher center, so that more patients can get the benefits of VATS.

Material and Methods: We performed a retrospective review case sheets of the patients diagnosed with empyema in our hospital, admitted in our hospital between December 2006 and December 2017. Age of the patients ranged from 3 years to 16 years. We analyzed demography, pus culture sensitivity, radio-diagnosis reports, treatment strategy, ICU stay, total hospital stay, complications and final outcome.

Results: 241 patients with empyema were managed through the study period in our department.  Sixty (37.7%) patients out of those (159) who were referred with chest tube from other hospitals have got greater duration of fever before admission to our hospital, and lesser patients (28.33%) underwent VATS. The patients referred without chest tube (99), were also having almost same rate of undergoing VATS. The patients (82) admitted primarily in our hospital, have got more rate of undergoing VATS (41.46%). Mean duration of fever before admission to our hospital was least (11+2 days) in patients, who were admitted primarily in our hospital and decision for surgical intervention taken earlier. Median length of hospital stay was least with VATS (6 days).

Conclusion: Although the patients in our study were not randomized, according to treatment strategy, but results indicate that as far as the surgical management is concerned, early referral to higher center with a facility of VATS is very important. It reduces the hospital stay, ICY stay and overall cost of the treatment.


Empyema, VATS, Video-assisted thoracoscopic surgery, thoracotomy, decortication, Pleural empyema


Andrews NC, Parker EF, Shaw RR, Wilson NJ, and Webb WR. (1962). “Management of non tubercular empyema: a statement of the subcommittee on surgery”, Am Rev Respir Dis, Vol.85, pp.935-936.

Aziz A, Healey JM, Qureshi F, Kane TD, Kurland G, and Green M, et al. (2008). “Comparative analysis of chest tube thoracostomy and video-assisted thoracoscopic surgery in empyema and parapneumonic effusion associated with pneumonia in children”, Surg Infect (Larchmt), Vol.9, pp.317-323.

Bilgin M, Akcali Y, and Oguzkaya F. (2006). “Benefits of early aggressive management of empyema thoracis”, ANZ J Surg, Vol.76, pp.120-122.

Byington C, Spencer L, and Johnson T, et al. (2002). “An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk fectors and microbiological associations”, Clin Infect Dis, Vol.34, pp.434-440.

Cardillo G, Carleo F, and Carbon L, et al. (2009). “Chronic post-pneumonic pleural empyema; Comparative merits of thoracoscopic versus open decortication”, Eur J Cardiothorac Surg, Vol.36, pp.914-918.

Chambers A, Routledge T, Dunning J, and Scarci M. (2010). “Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema?”, Interact Cardiovasc Thorac Surg, Vol.11, pp.171-177.

Coote N, and Kay E. (2005). “Surgical vs non-surgical management of pleural empyema”, Cochrane Database Syst Rev, Issue 4. Art No: CD001956.

Gates RL, Caniano DA, Hayes JR, and Arca MJ. (2004). “Does VATS provide optimal treatment of empyema in children? A systemic review”, J Pediatr Surg, Vol.39, pp381-386.

Goldin A, Parimi C, LaRiviere C, Garrison M, Larison C, and Sawin R. (2012). “Outcomes associated with type of intervention and timing in complex pediatric empyema”, Am J Surg, Vol.203, pp.665-673.

Gupta R, and Crowley S. (2006). “Increasing paediatric empyema admissions”, Thorax, Vol.61, pp.179-181.

Hamm H, and Light RW. (1997). “Parapneumonic effusion and empyema”, Eur Respir J, Vol.10, pp.1150-1156.

Hardie W, Bokulic R, Garcia V, Reising S, and Christie C. (1996). “Pneumococcal pleural empyemas in children”, Clin Infect Dis, Vol.22, pp.1057-1063.

Kern J, and Rodgers B. (1993). “Thoracoscopy in the management of empyema in children”, J Pediatr Surg, Vol.28, pp.1128-1132.

Light RW, Girard WM, Jenkison SG, and George RB. (1980). “Parapneumonic effusion”, Am J Med, Vol.69, pp.507-512.

Litchenstein R, Suggs A, and Campbell J. (2003). “Pediatric pneumonia”, Emerg Clin N Am, Vol.21, pp.451-473.

Luh SP, Chou MC, Wang LS, Chen JY, and Tsai TP. (2005). “Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas; outcome of 234 patients”, Chest, Vol.127, pp.1427-1432.

Meier AH, Hess CB, and Cilley RE. (2010). “Complications and treatment failures of video-assisted thoracoscopic debridement for pediatric empyema”, Pediatr Surg Int., Vol.26, pp.367-371.

Molnar TF. (2007). “Current surgical treatment of thoracic empyema in adults”, Eur J Cardiothorac Surg, Vol.32, pp.422-430.

Rosenstengel A. (2012). “Pleural infection-current diagnosis and management”, J Thorac Dis, Vol.4, pp.186-193.

Scarci M, Abah U, Solli P, Page A, Waller D, van Schil P, Melfi F, Schmid RA, Athanassiadi K, Sausa Uva M, and Cardillo G. (2015). “EACTS expert consensus statement for surgical management of pleural empyema”, Eur J Cardiothorac Surg, Vol.48, pp.642-653.

Schneider CR, Gauderer MW, Blackhurst D, Chandler JC, and Abrams RS. (2010). “Video-assisted thoracoscopic surgery as a primary intervention in pediatric parapneumonic effusion and empyema”, Am Surg, Vol.76, pp.957-961.

Schultz K, Fan L, and Pinskey J, et al. (2004). “The changing face of pleural empyemas in children: epidemiology and management”, Pediatrics, Vol.113, pp.1735-1740.

Shahin Y, Duffy J, Beggs D, Black E, and Majewski A. (2010). “Surgical management of primary empyema of the pleural cavity: outcome of 81 patients”, Interact Cardiovasc Thorac Surg, Vol.10, pp.565-567.

Shankar KR, Kenny SE, Okoye BO, Carty HM, Lloyed DA, and Losty PD. (2000). “Evolving experience in management of empyema thoracis”, Acta Pediatr, Vol.89, pp.417-420.

Solaini L, Prusciano F, and Bagioni P. (2007). “Video-assisted thoracoscopic surgery in the treatment of pleural empyema”, Surg Endosc, Vol.21, pp.280-284.

Spencer D, Iqbal S, Hasan A, and Hamilton L. (2006). “Empyema thoracis is still increasing in UK Children”, BMJ, Vol.332(7553), p.1333.

Waller DA, and Rengarajan A. (2001). “Thoracoscopic Decortication: A role of video-assisted surgery in chronic postpneumonic pleural empyema”, Ann Thorac Surg, Vol.71, pp.1813-1816.

Wozniac CJ, Paull DE, and Moezzi JE, et al. (2009). “Choice of intervention is related to outcomes in the management of empyema”, Ann Thorac Surg, Vol.87, pp.1525-1531.

Zahid I, Routledge T, and Bille A, et al. (2011). “What is the best treatment of postpneumonectomy empyema?”, Interact Cardiovasc Thorac Surg, Vol.12, pp.260-264.


  • There are currently no refbacks.

Send mail to with questions or comments about this web site. 

International Journal of Surgery and Surgical Sciences, All rights reserved.