Introduction: Empyema thoracis is defined as a collection of suppurative fluid in the pleural space. Pleural space infections arise secondary to a subjacent pneumonia or may complicate thoracic injury. In the paediatric population, parapneumonic effusion is the most frequent aetiology. Aims and Objectives: We undertook a study of all patients admitted between April 2014 to August 2019 with empyema thoracis who required surgical intervention in the form of intercostal drainage tube insertion, thoracotomy, thoracoscopy or a combination thereof. Materials and Methods: We did a retrospective study of 400 patients in Vadilal Sarabhai General Hospital, patients ranging from infancy to 14 years who presented with empyema thoracis. Conclusions: Video assisted thoracoscopic surgery is the preferred modality for the management of paediatric empyema if they present in the early stage as it is minimally invasive. More complicated empyema or those that present in the later stages need thoracotomy with decortication.