A Compare Study on Early and Late Thoracotomy in Pediatric Thoracis Empyema Cases

Dr. Shipra Sharma; Dr.Santosh Kumar Sonker

Volume : V, Issue : X, October - 2015

A Compare Study on Early and Late Thoracotomy in Pediatric Thoracis Empyema Cases

Dr. Shipra Sharma, Dr. Santosh Kumar Sonker

Abstract :

Introduction–In India, climate, socioeconomic conditions leading to poor hygiene, malnutrition, inadequate education, all favour infection and late referral, majority have intrathoracic infection, thus most common indication for thoracotomy management is empyema. Mainstay of treatment in empyema remains drainage of pus, deidement, and decortications with drain in the chest and systemic antibiotics. Recently video–assisted thoracoscopic (VATS) is good alternative to early thoracotomy and has certain advantages over conventional open surgery because there is limited trauma to the skin, muscles, nerves and other tissue, compared to open surgery, less post–operative pain adds to early and speedy recovery, because less pain promotes effective clearance of respiratory passage, by ability to cough out. Over all, in this study and also in developing country, early thoracotomy remains the standard procedure for managing pediatric thoracis empyema. Material and methods– In a large teaching hospital that is a tertiary–center, prospective study of 40 patient done early and late thoracotomy in all the symptomatic thoracis in all the symptomatic thoracis empyema cases in pediatric age group admitted in pediatric surgery ward under in the department of surgery, Dr.B.R.A.M. Hospital and Pt.J.N.M. Medical college Raipur, Chhattisgarh, India, ethical consideration most of the patient came to us for further management from primary and secondary referrals with typical history of cough and fever and where and where given a course of various antibiotics, however the fever persisted with gradual worsening of the general condition, increased techypnoea and respiratory distress. The treatment in all cases of thoracis empyema started as soon as diagnosis was suggested and confirmed by–relevant history, examination investigation. Data was compiled in MS–Excel and checked for its completeness and correctness. Then it was analyzed. Result – In this study, 40 patients included between 0 to 18 years of age: youngest patient was 5month and the oldest was 14 years. Seven patients (17.5%) were between 9 to 18 years of age and one patient (2.5%) was between 8 to 9 years of age. Twenty four (60%) patients had right sided disease and only 16th patient (40%) had left sided disease, no patient was found having bilateral disease. Out of 40 patients 33(82.5%) culture are sterile and following microorganism presents staphylococcus ssp.3 (7.5%), acid fast bacilli 1(2.5%), E.colli 3(5%) and pseudomonas ssp.3 (7.5%). Out of foury patients, 37(92%) patients with empyema, 2(5%) patient with pyoneumothorax. Chest tube removed around 9 days and hospital stay around 12 days in early thoracotomy and in late thoracotomy chest tube removed around 15days and hospital stay around 16 days. Conclusion– In the present study we found, early thoracotomy is remains standard treatment procedure for management of empyema because there is thin to turbid pus with no/minimal thickening of pleura or thick pus with fiin deposition on the pleura and no rib crowding is the usual picture, this can be managed well with early thoracotomy or early minithoracotomy, intercostals tube drain and systemic antibiotics. After early thoracotomy, general condition of the patient is improved rapidly, less postoperative pain and fever, time of surgery and blood loss is increased with physiotherapy and no significant surgical scar and long term complication like scoliosis and reduces morbidity and mortality.