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Ann Thorac Surg 2004;78:282-285
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

Thoracoscopic evacuation of retained posttraumatic hemothorax

Pradeep H. Navsaria, FCS(SA), MMed(Surg)a*, Richard J. Vogel, FCS(SA)a, Andrew J. Nicol, FCS(SA)a

a Department of Surgery, Trauma Unit, Groote Schuur Hospital and the Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Accepted for publication November 21, 2003.

* Address reprint requests to Dr Navsaria, Trauma Unit–C14, Groote Schuur Hospital, Anzio Rd, Observatory 7925, Cape Town, South Africa
e-mail: navsaria{at}uctgsh1.uct.ac.za

BACKGROUND: Residual posttraumatic hemothoraces occur in 1% to 20% of patients managed with tube thoracostomy. Video-assisted thoracoscopic surgery (VATS) has emerged as an alternative to thoracotomy to evacuate these retained collections. This report reviews a recent trauma unit experience with thoracoscopic evacuation of hemothoraces.

METHODS: The records of all trauma patients undergoing surgical intervention for retained hemothoraces over the 30-month period January 2001 to June 2003 were reviewed.

RESULTS: The study included 46 patients. All sustained penetrating injuries, 40 with stab and 6 with gunshot wounds. Twenty-two, 17, and 7 patients each had one, two and three attempts at drainage with tube thoracostomy, respectively. In 37 patients (80%), retained infected/uninfected pleural fluid was successfully evacuated thoracoscopically. VATS failed in 9 (20%) patients and the procedure was converted to open thoracotomy. Dense adhesions were present in all 9 of these patients. The mean time interval between injury and thoracoscopy and thoracotomy, was 13.3 days (range 3–46 days) and 14.5 days (range 11–24 days), respectively. The mean volume of pleural fluid evacuated thoracoscopically was 650 mL. The failure of VATS evacuation correlated with the empyema rate. The median postoperative stay was 5 days for both groups.

CONCLUSIONS: Video-assisted thoracoscopic surgery is an accurate, safe, and reliable operative therapy for retained posttraumatic pleural collections, even in patients presenting later than the conventionally accepted 3- to 5-day window from the time of injury.




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