Video-Assisted Thoracoscopic Surgery Versus Limited Posterolateral Thoracotomy for Management of Post Traumatic Clotted Hemothorax

Abstract

Background: Hemothorax is collection of blood in pleural cavity caused by blunt or sharp trauma.Retained hemothorax is an undrained collection in pleura that can lead to fibro-thorax or empyema. Chest tube placement is described as a method of management. Now, videoassisted thoracoscopic surgery (VATS) has evolved to become a gold standard in the management of retained hemothorax. Our objective is to compare VATS with limited thoracotomy in treatment of traumatic retained hemothorax. Patients and Methods: A prospective comparative study conducted on 60 patients with traumatic clotted hemothorax studied between January 2016 and December 2019. Patients were selected and classified into two groups each included 30 patients, Group I managed by open thoracotomy and group II managed by VATS. Results: Our study revealed no difference between both groups regarding age, gender, side of affection or preoperative ICT period. There were a significant reduction in operative time (55.67 Vs 101.3; P = 0.001), post-operative pain (P = 0.001) and postoperative period of ICT insertion (1.2 vs 1.2 day, P = 0.021) and postoperative total hospital stay (3.03 vs. 5.53 day; P = 0.001) and the period needed for return to normal activity (1.03 vs. 2.2 days; P = 0.01) in VATS group versus open thoracotomy group. Conclusion: We concluded that thoracoscopy is feasible, safe and tolerable method for management of retained traumatic hemothorax and so, we recommended it as a suitable method for this type of hemothorax. Key words: VATS; retained hemothorax; limited thoracotomy