The controversial role of decortication in the management of pediatric empyema

J Thorac Cardiovasc Surg. 1988 Jul;96(1):166-70.


Open surgical procedures for pleural empyema remain controversial in children. The pediatric literature generally recommends a prolonged trial of antibiotics and closed tube thoracostomy drainage. We report a favorable experience with a selective approach to open drainage in 22 children, many of whom had an empyema already organizing at admission. Open drainage was considered in children whose conditions failed to improve after 3 to 5 days of therapy with antibiotics and closed drainage. The method of drainage was selected according to the pathologic phase of the empyema: five children with fibrinopurulent empyema were successfully managed by limited decortication, and 17 with organizing empyema received decortication. Clinical improvement was usually dramatic; most of the children became afebrile by postoperative day 3 and were discharged by postoperative day 10. There were no deaths. Three children (14%) had complications of postoperative air leak or infection. Streptococcus pneumoniae (5) and Hemophilus influenzae (3) were the most common single pathogens. The presence of anaerobic bacteria in 8 of 22 children (36%) was associated with rapid organization of the empyema and the need for decortication. Decortication procedures have a low risk and are effective in children with empyema. They should be considered as definitive therapy, rather than as a last resort.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Drainage / methods
  • Empyema / surgery*
  • Female
  • Haemophilus Infections / surgery
  • Haemophilus influenzae / isolation & purification
  • Humans
  • Infant
  • Male
  • Pleura / surgery
  • Pneumococcal Infections / surgery
  • Thoracotomy