Objective Evaluate the results of thoracoscopy for the treatment of located pleural empyema.

Methods Retrospective study of 73 patients with loculated pleural empyema in pediatric surgery department of Monastir during the period between 1997–2010. Located empyema was confirmed in all patients through imaging (ultrasonography or tomography of chest).

Results The age of patients ranged between 2 months-16 years (mean age: 41.5 months) with a sex ration of 1.28. Fever was present in 98% of the cases. 25 patients had severe respiratory distress and mechanical ventilation was necessary in 4 cases. Bacteriology of the pleural liquid was positive in 12 cases. All patients had intravenous antibiotherapy during a mean period of 20 days. Sixteen patients (22%) were treated by thoracic drainage. Intrapleural fibrolysis was indicated in 5 cases (7%). One patient had an open thoracotomy for lung abscess with a loculated pleural empyema. Thoracoscopy was performed in 51 cases (70%). It was indicated after thoracic drainage failure in 14 cases. It was indicated for first-line before any prior thoracic drainage in 37 cases because of a multiloculated aspect at ultrasonography.

Conclusion Management of pleural empyema is still controversal in children and surgical indication is often delayed. Early first-line thoracoscoy yields a better clinical outcome for pediaric patients with pleural loculated empyema, with apparent decreased morbidity, earlier apyrexia, earlier chest tube removal, earlier hospital discharge and better response to antibiotherapy. Thoracoscopy prior to thoracic drainage can be indicated as first line treatment of loculated empyema for children.