{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:14:34Z","timestamp":1785442474816,"version":"3.56.0"},"reference-count":42,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>(1) Background: In children, bacterial pneumonia is the most common cause of parapneumonic pleural effusions which can eventually lead to pleural empyema. Treatment is varied and is a combination of antibiotic therapy, chest tube drainage, fibrinolytics and video-assisted thoracoscopic surgery (VATS). Postoperative complications of the latter include pneumothoraces and bronchopleural fistula (BPF). The aim of this study is to investigate the incidence and duration of pneumothoraces during the perioperative period and follow-up (FU) to elucidate their progression following video-assisted thoracoscopic surgery (VATS) to start to create an evidence-based standardized FU protocol. (2) Methods: This retrospective study included all patients who underwent VATS for pleural empyema between January 2013\u2013May 2023 at the University Medical Center Hamburg-Eppendorf (UKE) and the Hamburg Children\u2019s Hospital Altona (AKK). (3) Results: We identified 47 patients with pleural empyema who underwent VATS. A proportion of 43% of patients were found to have a pneumothorax with 55% of those being unresolved at discharge. At the end of FU, 27% of those had a \u201cpneumothorax ex vacuo\u201d. No surgical interventions were needed. (4) Conclusions: The majority of pneumothoraces after VATS in pediatric patients can be managed conservatively. In the context of follow-up care, it is recommended that X-ray examinations should be used sparingly, while sonographic follow-up examinations should be conducted more frequently. If the pneumothorax persists, further thoracoscopy for resection of the visceral pleura and treatment of bronchopleural fistula may be the next step in treatment.<\/jats:p>","DOI":"10.3390\/children12020154","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T06:47:29Z","timestamp":1738046849000},"page":"154","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pneumothorax After VATS for Pleural Empyema in Pediatric Patients"],"prefix":"10.3390","volume":"12","author":[{"given":"Nariman","family":"Mokhaberi","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"},{"name":"Department of Pediatric Surgery, Hamburg Children\u2019s Hospital Altona, 22763 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3808-9119","authenticated-orcid":false,"given":"Vasileios","family":"Vasileiadis","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Hamburg Children\u2019s Hospital Altona, 22763 Hamburg, Germany"},{"name":"Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3BH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Malte","family":"Ambs","sequence":"additional","affiliation":[{"name":"Department of Pediatric Radiology, Hamburg Children\u2019s Hospital Altona, 22763 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7142-8758","authenticated-orcid":false,"given":"Konrad","family":"Reinshagen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"},{"name":"Department of Pediatric Surgery, Hamburg Children\u2019s Hospital Altona, 22763 Hamburg, Germany"},{"name":"German Center for Child and Adolescent Health (DZKJ), Partner Site Hamburg, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s41479-017-0035-0","article-title":"Necrotizing Pneumonia: An Emerging Problem in Children?","volume":"9","author":"Masters","year":"2017","journal-title":"Pneumonia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e129","DOI":"10.1016\/j.jtcvs.2017.01.030","article-title":"The American Association for Thoracic Surgery Consensus Guidelines for the Management of Empyema","volume":"153","author":"Shen","year":"2017","journal-title":"J. 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