PURPOSE: Chest tube insertion is the first and only treatment modality for traumatic hemothorax in the majority of general surgical departments.Since 2004 we have an arrangement with all general surgical departments of our region to treat primary or secondary all patients with thoracic trauma in our thoracic surgical unit.
METHODS: Between 1/2004 and 12/2005 23 patients (18 male, 5 female) underwent VATS for the treatment of traumatic hemothorax. The mean age was 53 years (16-87 years). 15 patients were initially admitted and treated in general surgical departments. 8 patients have been admitted primary in our thoracic surgical unit. 15 patients presented with hemo- or clotted hemothorax, 8 patients with hemo-pneumothorax. The origin of hemothorax was different: 8 accidental falls, 6 road accidents, 4 iatrogen, 3 knife wounds, 1 gun shot and 1 penetrating chest trauma.11 patients had rib or serial rib fractures, 10 patients lung lacerations and 4 patients additional diaphragmatic lesions.
RESULTS: Nine patients were treated with VATS on trauma day. On average the operative treatment occurred 5 days (0-21d) after trauma. In 2 cases a supporting minimal thoracotomy was necessary. 1 patient had been reoperated 2 days later according to a postoperative intrathoracal bleeding. No patient died . The length of hospital (LOS) was 9.6 days (2-22d), the LOS postoperatively was 7.6 days.
CONCLUSION: VATS is a safe technique for primary or early treatment for all cases of hemothorax. In comparison to the primary drainage with chest tube it allows an early and sufficient drainage of hemothorax and clotted hemothorax and a quick check of all intrathoracic structures with the possibility of operative treatment in one time.
CLINICAL IMPLICATIONS: We recommend the VATS for inspection and treatment of all forms of traumatic hemothorax.
DISCLOSURE: Erich Hecker, None.