Early evacuation of posttraumatic clotted hemothorax or retained pleural fluid: result of vats versus conventional thoracotomy

ABSTRACT

To compare the outcome of VATS versus conventional thoracotomy in the early evacuation of posttraumatic clotted hemaothorax or retained pleural fluid in patients with chest trauma after failure of the initial management with tube thoracostomy. Between January 2001 and December 2005, fifty-four patients with posttraumatic clotted hemothorax or retained pleural fluid were included in this study. They were claimed to have clotted hemothorax or retained pleural fluid after 3 to 5 days posttruama by chest roentgenogram and chest CT. The patients were divided into 2 groups, group I [VATS group] and group II [thoracotomy group]. Group I patients [VATS group] included 23 patients, VATS was performed for evacuation of posttraumatic clotted hemaothorax or retained pleural fluid. Group II patients [thoracotomy group] included 31 patients; conventional thoracotomy was performed for management of posttraumatic clotted hemothorax. There was no statistical significant difference between the mean ages of both groups, as the mean age of the VATS group patients was 33 +/- 8 years, while it was 32.7 +/- 7 years for the thoracotomy group patients. The mean preoperative ICT period was [6 +/- 1.5 days VS 7 +/- 2 days respectively]. It was statistically non-significant There was statistical significant difference [P-value VATS group patients and the thoracotomy group patients in the mean operative time [70 +/- 4 minutes VS 77 +/- 6 minutes respectively], and, mean volume of analgesics given in the first 24 hours postoperatively [201 +/- 17 mg VS 239 +/- 18 mg respectively], in the mean ICT drainage in the first 24 hours post-operatively [219 +/- 22 ml VS 230 +/- 18 ml respectively], and, mean ICT period postoperatively [4 +/- 1 days VS 6.5 +/- 1 days respectively].There was also statistical significant difference between the 2 groups of patients in the mean hospital stay postoperatively [6 +/- 3 days VS 10 +/- 2.5 days respectively], and, the mean period to return to more or less normal activity [15 +/- 1.8 days VS 23 +/- 3.5 days respectively]. Complications occurred less in VATS group of patients than that of thoracotomy group of patients. Prolonged air leak [13% VS 20%, respectively], postoperative empyema [4% VS 10%, respectively] and wound infection [0% VS 10%, respectively]. Reoperationfor management of postoperative empyema performed in one patient [4%] of the VATS group of patients and 2 patients [6%] of the thoracotomy group of patients. We concluded that early thoracoscopic intervention should be considered for management of posttraumatic clotted hemothorax or retained pleural fluid. Benefits include abbreviated thoracostomy tube drainage, shorter hospital stay after procedure, shorter overall hospitalization, as well as early return to normal activity. Moreover, early evacuation usually decrease the complications associated with retained hemothoraces, such as empyema and fibrothorax. Also, thoracoscopic surgery has fewer complications than the conventional thoracotomy