Thoracoscopic evacuation compared with reinsertion of thoracostomy tube in persistent traumatic hemothorax

Objective
Hemothorax is the most frequent complication from chest trauma. In most of the cases, chest tube will be sufficient for treatment, but in a minority of patients, more intervention will be needed to evacuate a retained hemothorax. We aimed in this study to compare between video-assisted thoracoscopy (VATS) evacuation of retained clotted blood and reinsertion of thoracostomy tube to explore the safety and complications of such techniques.
Patients and methods
A prospective randomized case–control study was conducted on patients who presented with retained hemothorax admitted to trauma unit from July 2017 to July 2018.
Results
During the time frame from July 2017 to July 2018, our trauma unit got 44 879 patients. Approximately 14 722 of them needed admission, with only 288 patients requiring primary chest tube for hemothorax, of which 35 patients met the inclusion criteria of this study. They were then divided into two groups: group A (16 patients) underwent evacuation by VATS. The operative time for VATS ranged from 24 to 130 min, with mean time 79.8 min (after VATS), and needed drainage days range from 2 to 7 days, with mean of 3.31 days. One (6.25%) patient need thoracotomy. No wound infection or empyema was present in group A. Control group (group B) included 19 patients in whom the chest tube was reinserted. The needed days of drainage range from 4 to 10 days, with mean 6.47 days, with significant value ( = 0.001). Three (15.78%) patients had wound infection at the site of thoracostomy tube. On follow-up, we noticed four (20.05%) patients with empyema.
Conclusion
Early VATS for evacuation of retained hemothorax is feasible and safe in trauma patients. Moreover, VATS evacuation leads to shorter hospital stay and less need for open thoracotomy in comparison with reinsertion of a chest tube.