Objective: To evaluate the relation between the timing of thoracoscopic debridement (TD) and morbidity in children with advanced pleural empyema (PA).

Material and Method: The children managed for advanced stage PA between January 2010 and March 2019 were included. Additional interventions, complications, length of hospital stay and duration of symptoms and thoracic drainage were retrospectively evaluated. Patients were divided into 2 groups according to median duration of symptoms. Statistical analysis was performed by IBM SPSS software, p <0.05 values were set as significant.

Results: A total of 98 children were enrolled in the study. Tube thoracostomy (TT) was performed in 52 children (53%) and TD in 46 (47%) as the initial intervention. Nine patients recovered (17%) with TT alone and the rest 43 (83%) required additional TD. Median duration of symptoms was 10 days (4-60 days). The median length of thoracic drainage after TD was 8 days (3-12 days) in patients with symptom duration ≤10 days (Group 1), while it was 14 days (3-30 days) in patients with symptom duration >10 days (Group2). Median length of stay was 10.5 days (4-26) in Group 1 and 20 days (4-56) in Group 2. These two parameters were significantly lower in Group 1 (p <0.05). Bronchopleural fistula developped in 1 patient after TD (1.12%), 5 patients underwent a second TD (5.61%) and 4 patients needed thoracostomy (4,49%). One patient was deceased.

Conclusion: TD is an effective management modality in advanced PA and may be considered as initial option to reduce morbidity.