Thoracoscopic evacuation of retained posttraumatic hemothorax.
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.
Navsaria
Pradeep H
PH
Department of Surgery, Trauma Unit, Groote Schuur Hospital and the Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. navasaria@uctgsh1.uct.ac.za
Vogel
Richard J
RJ
Nicol
Andrew J
AJ
D000293:Adolescent; D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D016724:Empyema, Pleural / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005334:Fever / Q000209:etiology; D006491:Hemothorax / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013396:Suction; D013898:Thoracic Injuries / Q000150:complications*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications; D014950:Wounds, Penetrating / Q000150:complications*; D014951:Wounds, Stab / Q000150:complications
D019980:Amoxicillin-Potassium Clavulanate Combination