Objectives: To evaluate whether external negative suction is more advantageous than only water seal in pediatric patients
developing post-operative persistent air leak undergoing decortication for empyema thorax.
Methods: A retrospective analysis was done of all patients being admitted for empyema thorax at our centre from 2010 – 2019.
Of these, total 180 patients with stage 2 and 3 empyema were identified and evaluated closely. Age distribution, sex prevalence,
investigations performed, and treatment received was noted. Postoperatively patients developing persistent air leak (PAL) were
compared with respect to grade of empyema, surgery performed, and postoperative negative suction applied or not. Their time to
resolution of air leak after first 4 days post operatively was compared.
Results: Of 180 patients 107 had grade four persistent air leaks even after 4 days of underwater seal drainage, of these 20
patients were excluded as per exclusion criteria. Remaining 87 patients were divided in two comparable groups. From 2010 – 2013
patients were not receiving postoperative negative suction for PAL they were managed on under-water seal drainage only. During
this period, 36 such patients were found. Their time for resolution of air leak was compared with 51 patients who had received
negative suction for PAL from 2014-2019. The primary end point was the time elapsed between placement and removal of drains.
All the data was analysed, and comparisons done. This was then subjected to statistical analysis and tests. No significant difference
was found in the two groups. Whether the negative suction was applied or not the time to stoppage of air leak or recovery was
Conclusion: In Pediatric patients undergoing decortication for empyema thorax; either VATS or Open; applying negative suction
to intercostal drainage offers no additional advantage in closure of PAL or recovery.
Abbreviations:PAL: Persistent Air Leak; VATS: Video Assisted Thoracosopic Decortication; CECT: Contrast Enhanced Computed
Tomography; STS: Society of Thoracic Surgeons