Decortication in Paediatric Patients

Abstract

empyema continues to cause significant morbidity worldwide, particularly in developing regions. Despite modern antibiotic therapy and minimally invasive interventions, a considerable number of children progress to chronic empyema and fibrothorax, ultimately requiring surgical decortication. Objective: To analyze the outcomes of paediatric patients undergoing decortication for chronic empyema and fibrothorax, with a focus on etiology, postoperative complications, and surgical results. Methods: A prospective descriptive study was conducted in the Department of Cardiothoracic Surgery at Ayub Teaching Hospital, Abbottabad, from June 2014 to May 2022. A total of 180 children aged 2–16 years underwent thoracotomy and decortication for chronic empyema. Data were collected on demographics, etiology, intraoperative findings, postoperative complications, and outcomes. Results: The most common etiology was parapneumonic empyema, observed in 95% of cases, followed by tuberculous empyema in 4% and miscellaneous causes in 1%. Adequate lung expansion was achieved in 99% of patients. Postoperative complications included wound infection in 1.5% and prolonged air leak in 4.5%. Overall mortality was 1.1% (2 out of 180 patients). Conclusion: Decortication by thoracotomy in children with chronic empyema is a safe and highly effective procedure. With excellent rates of lung re-expansion and low complication rates, it remains the gold standard in advanced empyema where medical and minimally invasive approaches fail.