Complex minimally invasive approach for complicated parapneumonic pulmonary abscess with bronchopleural fistula in childhood

Introduction: Parapneumonic lung abscess in childhood is a severe disease with peak incidence between 1 and 6 years of age. There is a clear trend of increasing frequency of its appearance for the last 15 years. The causes for that are multiple – nature of microbiological pathogens, specificity of children’s immunity, late diagnosis and others. Video-assisted thoracoscopic surgery (VATS) is a gold standard for treatment of the parapneumonic pleural and pulmonary complications. One of the most serious complications of the lung abscess still remains the development of bronchopleural fistula (BPF) in the postoperative period (incidence 4.5-20% in various publications). Aim: To discuss the advantages of VATS-abscessotomy and complex bronchoscopic treatment of complicated lung abscess and BPF. Methods: Ultrasonography was used for staging of the pleural effusion (according to a modified-Hilliard protocol). Computed tomography and X-Ray were used for additional diagnostics an follow-up. 2- or 3-port conventional VATS with abscessotomy and drainage were used in all patients. Rigid and flexible bronchoscopy with placing a synthetic bronchial blocker were used for BPF-occlusion. Results: 95 children aged from 1 to 18 years old underwent VATS for pulmonary abscess in the period 2008-2019. 33 of them underwent subsequent thoracotomy and 21 patients were treated only with VATS and bronchoscopic occlusion of (BPF). Conclusion: Combination between VATS and bronchoscopic occlusion of BPF decreases the necessity of wide lung resections. When used as a first method of choice VATS-abscessotomy prevents large volume resections if subsequent thoracotomy is needed.