Empyema thoracis: Controversies and technical hints

This communication is the summary of Internet discussions held by members of the Indian Association of Pediatric Surgeons (IAPS) in June 2005. It reflects the opinion and practice of Indian pediatric surgeons on the treatment of childhood empyema thoracis (ET). Despite the availability of broad-spectrum antibiotics, a large number of ET in advanced stages is still seen in India. The management of ET appears to depend on the stage of pathology, the status of underlying lung and proper usage of antibiotic adjuncts. Intercostal tube drainage of pleural space is sufficient for stage 1 empyema. Thoracoscopic decortication reduces the treatment cost and morbidity of stage 2 disease. However, stage 3 lesions with very thick pleural peels require open decortication. Pros and cons of these three modalities of treatment are discussed. The members also describe the various innovative techniques, that they found useful in the surgical management of ET.