PURPOSE: To review our experience about the treatment of spontaneous hemopneumothorax (SHP) by video-assisted thoracoscopic surgery (VATS).
METHODS: Sixteen patients with prominent SHP (blood loss over 400 cc in the initial 24 hours) undergoing VATS from July, 1994 to December, 2005.
RESULTS: Fourteen male and two female, with ages ranging from 16 to 38 years (mean, 26.1 years) were treated with VATS for prominent SHP, which cannot effectively treated by tube drainage or with persistent air-leakage. There were thirteen patients (81.3%) who could be identified with prominent bleeding sources intra-operatively, and all the bleeders were originated from the parietal instead of visceral part of the pleura. Torn engorged vessels from the parietal pleura to the bullae could be found in nine of them, and for the other four patients there were bleeders adjacent or over the parietal part of the adhered pleura. Ruptured bullae/blebs or air-leakage could be found in fourteen (87.5%) of them over the visceral pleura adjacent to the bleeders. All of them underwent removal of intrapleural blood clot, control bleeders and bullae/blebs resection) through three-ports VATS (n=13, 81.3%) or minithoracotomy and VATS (n=3, two scheduled procedure because of unstable vital signs and one conversion from VATS because of dense adhesion). Mechanical (gauze abrasion) and/or chemical (minocin intrapleural injection) pleurodesis were added in all patients. The mean operative time was 53.8± 21.7 minutes (range, 35-120). There was no postoperative mortality. However, recurrent bleeding occurred in one patient (6.3%) and recovered after re-operation. There was one another case with prolonged air leakage (> 7days) postoperatively and recovered spontaneously. The mean duration of chest tube drainage was 3.8 days and the median follow up period was 3.2 years.
CONCLUSION: SHP complicated by severe bleeding is a surgical emergency. VATS can be considered as a feasible treatment for patients with SHP.
CLINICAL IMPLICATIONS: Poorly controlled bleeders on SHP should be mostly from the parietal pleura because of the direction of blood flow and the tension differences.
DISCLOSURE: Shi-Ping Luh, None.