PURPOSE: Video-assisted thoracic surgery (VATS) is increasingly being accepted as the approach of choice for a number of thoracic conditions. This study presents over two decades of experience from our institution on management of spontaneous hemopneumothorax (SHP), with particular reference to the use of VATS.
METHODS: Retrospective review between March 1988 and December 2010 with 53 patients with SHP, accounting for 4.1% of all patients treated for spontaneous pneumothorax. The clinical features, operative details and outcomes are analyzed.
RESULTS: Fifty-one SHP patients were male, with mean age of 23.6 years. Signs of significant hypovolemia occurred in 9 patients, 5 required blood transfusion. Mean initial blood drainage from tube thoracostomy was 473 ml (range 0-2100 mls). All SHP patients received surgery (5 thoracotomies, 48 VATS). Active bleeding was identified intra-operatively in 34 (64%) patients; 20 from torn apical vascular adhesions, 9 from torn vascular adhesions from multiple sites and 5 from vascular bleb. Postoperative complications after thoracotomy include 2 chest infections and 1 air leak, while VATS had 3 chest infections and 2 air leaks (p = 0.02). Mean postoperative hospital stay following VATS was 3.6 days and thoracotomy 7.5 days (p = 0.0018). There was 1 (1.9%) recurrence of pneumothorax following a previous VATS hemostasis pleurodesis for SHP. The mean follow-up is 94 months (range 4-249 months).
CONCLUSIONS: SHP is a potentially life threatening condition and a cause for patients presenting with unexplained signs of hypovolemia. Early surgery is a safe and effective approach to manage patients with SHP. Minimal invasive VATS can result in less postoperative complications and shorter hospital stay compared with open thoracotomy.
CLINICAL IMPLICATIONS: VATS should be the standard of care, and considered early in the management of SHP.
DISCLOSURE: The following authors have nothing to disclose: Calvin Ng, Randolph Wong, Eugene Yeung, Micky Kwok, Innes Wan, Song Wan, Anthony Yim, Malcolm Underwood
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