Video-assisted thoracic surgery for primary spontaneous hemopneumothorax.
OBJECTIVE
Video-assisted thoracic surgery (VATS) has changed the way we manage a number of thoracic conditions. This study presents near over a decade of experience from our institution on management of spontaneous hemopneumothorax (SHP), with particular reference to the use of VATS.


METHODS
Retrospective review between March 1988 and December 2002 with 793 patients treated for spontaneous pneumothorax, 30 (3.8%) patients had SHP. The clinical features, indications for surgery and outcomes are discussed.


RESULTS
All 30 SHP patients were male with mean age of 25 years. Signs of significant hypovolemia occurred in 4 patients, 3 required blood transfusion. Mean initial blood drainage from tube thoracostomy was 594 ml. All SHP patients received surgery (5 thoracotomies, 25 VATS). Active bleeding was identified in 16 patients; 12 from torn apical vascular adhesion band and 4 from vascular bleb. Postoperative complications after thoracotomy include 2 chest infections and 1 air leak, while VATS had 1 chest infection and 1 air leak (P=0.022). Mean postoperative hospital stay following VATS was 3.9 days and thoracotomy 7.5 days (P=0.0021). There is no recurrence of pneumothorax or SHP during mean follow-up of 21 months.


CONCLUSIONS
SHP can be life threatening and is a cause for patients presenting with unexplained signs of significant hypovolemia. Surgery in the form of VATS should be considered early in the management of SHP, with potentially less postoperative complications and shorter postoperative hospital stay compared with open thoracotomy.
Hwong
Thomas M T
TM
Division of Cardiothoracic Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
Ng
Calvin S H
CS
Lee
Tak Wai
TW
Wan
Song
S
Sihoe
Alan D L
AD
Wan
Innes Y P
IY
Arifi
Ahmed A
AA
Yim
Anthony P C
AP
D000293:Adolescent; D000328:Adult; D006468:Hemopneumothorax / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D016896:Treatment Outcome