[Early decortication in the surgical treatment of pleural empyema in childhood: indications and results].

Antibiotics and pleural drainage with continuous suction is effective in treatment of childhood pleural empyema. However a recognizable number of childhood pleural empyema fail to improve or to cure after this treatment. This study reviews our experience with 27 children over past 8 years. All patients were treated with antibiotics, seven with only pleural drainage, twenty with pulmonary decortication. Indications for decortication were: clinical and radiological failure after 4-5 days of treatment with pleural drainage and continuous suction; persistent fever; persistent respiratory distress; persistent signs of general illness; persistent loculated pleural effusions; worsening parenchymal disease. The clinical and radiological improvements following decortication were dramatic with immediate lung reexpansion and improvement of clinical course. The chest tubes were removed by the fifth postoperative day and the children were discharged by the seventh-nine postoperative day. There were no complications and no deaths. In our experience pulmonary decortication is a simple and effective treatment of childhood empyema in the advanced fibro-purulent and/or early organizing phase with immediate and long-term excellent results.