Thoracoscopic evacuation of retained post-traumatic hemothorax

ABSTRACT

Post-traumatic retained hemothorax is a major risk factor for empyema thoracis leading to prolonged hospitalization, entrapped lung and a need for decortication. VATS [Video Assisted Thoracoscopy] for retained hemothorax shortens the duration of chest tube drainage and length of stay. From December 2004 to July 2009, 110 consecutive patients underwent VATS for retained or clotted hemothoraces at the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi. Majority of the patients were males [n = 91; 82.7%]. Sixty-five patients [59.1%] underwent VATS within 6 days and 45 patients [40.9%] between 7 - 14 days of injury. In 8 patients [7.3%] VATS was abandoned for thoracotomy. Post VATS full lung expansion was achieved in 87 patients [79.0] with complete evacuation of hemothorax. Chest tubes were removed within the first week in 100 patients [90.9%]. In hemodynamically stable patients, VATS is a safe, reliable and effective technique for the evacuation of retained hemothorax. Early intervention within 6 days of injury avoids the need for a thoracotomy and is associated with a better short and long-term outcome: