Eficacia de la cirugía videotoracoscópica en el tratamiento del derrame pleural paraneumónico complicado en niños

Background: the simple drainage through a chest tube in children with complicated parapneumonic pleural effusion is generally insufficient. These patients usually have unfavorable outcome, and frequently a surgical treatment with decortication is necessary. Objective: to evaluate the results of the introducion of video assisted thoracic surgery in children with complicated parapneumonic pleural effusion. Methods: a quasi-experimental study was conducted in patients with complicated parapneumonic pleural effusion in the Pediatric Hospital “Eduardo Agramonte Pina” in Camaguey, Cuba, from January 2011 to December 2015. Two groups were compared: the study group composed of patients who underwent at least one video assisted thoracic surgery, and the control group that included patients of a historical cohort who also met the inclusion criteria and whose admission date was between January 2006 and December 2010. The variables to assess the primary outcome were resolution of the effusion, the need for open decortication, and mortality. Results: the time with the chest tube was significantly higher for the control group, with a difference of 2.3 days on average. The efficacy of video assisted thoracic surgery was superior to completely evacuate pleural effusion and significantly reduced the time of hospitalization in intensive care, from 10.3 days to 5.4 days on average. However, the reduction of the total hospital stay was not significant. None of the patients from the study group required decortication by thoracotomy, which was necessary in six patients from the control group. There was no mortality associated with surgical intervention. Conclusions: video assisted thoracic surgery has been shown to be effective in children with complicated paraneumonic pleural effusion without association to mortality or serious complications. DeCS: EMPYEMA, PLEURAL/surgery; THORACIC SURGERY, VIDEO-ASSISTED; THORACOTOMY; CHILD; NON-RANDOMIZED CONTROLLED TRIALS AS TOPIC.