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Outcomes of surgical treatment of tuberculous empyema in children and adolescents

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Abstract

DOI: 10.32364/2587-6821-2026-10-9-20

Outcomes of surgical treatment of tuberculous empyema in children and adolescents

M.V. Sinitsyn^1,2, E.Yu. Yakovleva¹, N.S. Stepanenko¹, A.V. Itskov¹, A.S. Bikbaev¹, T.A. Gazdanov¹

¹ National Medical Research Center of Phtysiopulmonology and Infectious Diseases, Moscow, Russian Federation

² Pirogov Russian National Research Medical University, Moscow, Russian Federation

Background: in tuberculosis patients, specific pleural involvement is associated with exudate or pus accumulation in the pleural cavity followed by empyema. Etiotropic chemotherapy used to manage empyema is characterized by limited efficacy; typically, a patient cannot be cured completely without surgical methods.

To treat empyema, the pleural cavity is gradually punctured and drained. If ineffective, a surgeon removes empyema cavity walls with subsequent pleurectomy and lung decortication. Potential surgical techniques depend on a number of factors (mainly, the presence of a bronchial fistula, location and site of empyema). Tuberculous empyema (TE), especially in children, is still a challenge for thoracic surgery, and literature data on minimally invasive surgical treatment of TE in children are limited. Advanced minimally invasive technologies (video-assisted thoracic surgery, laser surgery) can improve TE treatment outcomes in children and adolescents.

Aim: to evaluate efficacy of minimally invasive surgical treatment in children and adolescents with TE.

Materials and Methods: 40 pediatric patients operated in 2018–2025 were enrolled in a retrospective single-center cohort study. The disease site, bacterial excretion and drug resistance of the pathogen were analysed. Surgical intervention types, as well as complication and mortality rates were evaluated.

Results: 40 surgeries were performed in children and adolescents. All the operations were performed by minimally invasive techniques; a neodymium laser was used in 4 (10%) subjects. Complications were reported in 1 (2.5%) patient, mortality was 0%. Treatment efficacy was 97.5%.

Conclusion: minimally invasive techniques demonstrate high efficacy of surgical TE treatment in children and adolescents. Timely referral of pediatric patients for surgical treatment helps to decrease injury rate of the intervention, to reduce duration of inpatient treatment and to improve functional outcomes.

Keywords: tuberculous empyema in children, minimally invasive surgical treatment, drug resistance.

For citation: Sinitsyn M.V., Yakovleva E.Yu., Stepanenko N.S., Itskov A.V., Bikbaev A.S., Gazdanov T.A. Outcomes of surgical treatment of tuberculous empyema in children and adolescents. Russian Medical Inquiry. 2026;10(9):759–765 (in Russ.). DOI: 10.32364/2587-6821-2026-10-9-20

About the authors:

Mikhail V. Sinitsyn — Dr. Sc. (Med.), Deputy Chief Physician for Surgery, National Medical Research Center of Phthisiopulmonology and Infectious Diseases; 4, bldg. 2, Dostoevsky str., Moscow, 127473, Russian Federation; Professor of the Department of Phthisiology, Pirogov Russian National Research Medical University; 1, bldg. 6, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0000-0001-8951-5219

Elena Yu. Yakovleva — Thoracic Surgeon of the Tuberculosis Pulmonary Surgical Department of National Medical Research Center of Phthisiopulmonology and Infectious Diseases; 4, bldg. 2, Dostoevsky str., Moscow, 127473, Russian Federation; ORCID iD 0009-0007-5432-3410

Nikita S. Stepanenko — C. Sc. (Med.), Pediatric Surgeon, National Medical Research Center of Phthisiopulmonology and Infectious Diseases; 4, bldg. 2, Dostoevsky str., Moscow, 127473, Russian Federation; ORCID iD 0000-0002-2827-1764

Alexander V. Itskov — Board-Certified Doctor, Thoracic Surgeon, Head of the Tuberculosis Pulmonary Surgical Department, National Medical Research Center of Phthisiopulmonology and Infectious Diseases; 4, bldg. 2, Dostoevsky str., Moscow, 127473, Russian Federation; ORCID iD 0009-0005-9491-6654

Alexander S. Bikbaev — Thoracic Surgeon of the Tuberculosis Pulmonary Surgical Department, National Medical Research Center of Phthisiopulmonology and Infectious Diseases; 4, bldg. 2, Dostoevsky str., Moscow, 127473, Russian Federation; ORCID iD 0000-0001-5548-9534

Tamerlan A. Gazdanov — Board-Certified Doctor, Thoracic Surgeon, Tuberculosis Pulmonary Surgical Department, National Medical Research Center of Phthisiopulmonology and Infectious Diseases; 4, bldg. 2, Dostoevsky str., Moscow, 127473, Russian Federation; ORCID iD 0009-0007-0019-6997

Contact information: Elena Yu. Yakovleva, e-mail: chernayamamba1990@mail.ru

Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.

There is no conflict of interest.

Received 03.07.2026.

Revised 28.07.2026.

Accepted 20.08.2026.

References

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