Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax.
OBJECTIVE
To determine the best timing for thoracoscopic drainage of clotted hemothorax in order to ensure safe and effective results and to identify risk factors associated with drainage failure.


METHODS
Cohort retrospective study of 139 consecutive patients who underwent thoracoscopic retained hemothorax drainage between April 1997 and May 2005.


RESULTS
The procedure was successful in 102 patients (73.4%), in whom complete evacuation was achieved, with no accumulation of fluid in the pleural cavity requiring reintervention. Conversion to thoracotomy was required in 22 patients (15.8%) because of the inability to attain adequate drainage of clots and collections and lung re-expansion. Fifteen patients (10.8%) required reintervention as a result of fluid accumulation in the pleural cavity and lung collapse, and thoracotomy was performed in all those cases. The best results were obtained when thoracoscopic drainage was performed before the fifth day. There were 33 major post-operative complications including 20 cases of empyema of which 10 required thoracotomy, and 13 bronchopleural leaks, four of which required open surgery. There were no fatal outcomes in the study group.


CONCLUSIONS
Videothoracoscopy must be considered the procedure of choice for the treatment of retained post-traumatic hemothorax. It is a safe and effective procedure allowing the successful treatment of up to 73.4% of patients. Best results are obtained when drainage is performed within the first five days after trauma.
Morales Uribe
Carlos H
CH
Surgery Department, Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, AA 1226 Postal 229, Ciudad Universitaria, Medellín, Colombia South América. cmorales@epm.net.co
Villegas Lanau
Maria I
MI
Petro Sánchez
Rubén D
RD
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006491:Hemothorax / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome