The Role of Thoracoscopy in the Management of Retained Thoracic Collections After Trauma

Heniford, B. Todd; Carrillo, Eddy H.; Spain, David A.; Sosa, Jorge; Fulton, Robert L.; Richardson, J. David

doi:10.1016/s0003-4975(97)00173-2

Cited by 131 publications

(88 citation statements)

References 16 publications

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“…The cumulative 10.5% incidence of RH was consistent with other reports in the literature, where the incidence ranges from 4% to 20% 7,9,17 . The trauma indices were consistent with low severity of the patients.…”

Section: Discussion Discussion Discussion Discussion Discussionsupporting

confidence: 90%

“…However, this definition is still not uniform in the medical literature 6 . Less invasive procedures have been early indicated for treatment of RH [7][8][9][10][11][12] . The main goal of the early treatment is to avoid the RH progression to other complications, especially to empyema, one of the most severe complication which frequently requires a complex approach for treatment 5,12,13 .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

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Associated factors to empyema in post-traumatic hemotorax

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Resende

Machado

et al. 2015

Rev. Col. Bras. Cir.

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Objective:to analyze the associated factors with empyema in patients with post-traumatic retained hemothorax.Methods:prospective observational study. Data were collected in patients undergoing PD during emergency duty. Variables analyzed were age, sex, mechanism of injury, side of the chest injury, intrathoracic complications of RH, laparotomy, specific injuries, rib fractures, trauma scores, days to diagnosis, diagnostic method of RH, primary indication of PD, initial volume drained, length of the first tube removal, surgical procedure. Cumulative incidence of empyema, pneumonia and pulmonary contusion and the proportion of patients with empyema or without empyema in each category of each variable analyzed were obtained.Results: the cumulative incidence of PD among trauma patients was 1.83% and the RH among those with PD was 10.63%. There were 20 cases of empyema (32.8%). Most were male in the age from 20 to 29, victims of injury by firearm on the left side of the thorax. The incidence of empyema in patients with injury by firearms was lower compared to those with stab wound or blunt trauma; higher among those with drained volume between 300 and 599 ml. The median hospital lenght of stay was higher among those with empyema.Conclusion:the incidence of PD was 1.83% and RH was 10.63%, these results are consistent with the low severity of the patients involved in this study and consistent with the literature. The incidence of empyema proved to be negatively associated with the occurrence of injury by firearms and positively associated with a drained volume between 300 and 599 ml, compared with lower or higher volumes.

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Section: Discussion Discussion Discussion Discussion Discussionsupporting

confidence: 90%

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Associated factors to empyema in post-traumatic hemotorax

Neto

Resende

Machado

et al. 2015

Rev. Col. Bras. Cir.

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“…[6,10,16,[19][20][21] Çalışmamızda tüp torakostomi ile tedavi edilen olgularda morbidite oranı %50, VATS ile tedavi edilenlerde %10 olarak tespit edilmiştir. En sık görülen komplikasyonun retansiyone hemotoraks (%23,3) ve ampiyem (%13,3) olması literatürleri [6,10,16,[19][20][21] desteklemekte ve göğüs tüpü ile yeterince drene edilemeyen hemotoraksın komplikasyon oranını artırdığı-nı işaret etmektedir.…”

Section: Discussionunclassified

Should videothorascopic surgery be the first choice in isolated traumatic hemothorax ? Prospective randomised controlled study

Çobanoğlu¹,

Sayır²,

Mergan³

2011

Ulus Travma Acil Cerrahi Derg

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“…The topic of time between diagnosis of the hemothorax and thoracoscopic drainage, probably affecting lowest complications rate and better outcomes, has not been fully clarified in the literature. Various studies showed that early evacuation results in less complications: but, while some authors (17,18) recommend the surgical procedure performed within 3 days following the diagnosis, others report successful outcomes in trauma patients when this is accomplished after 7 or more days (19,20). Villegas et al in their series of 139 patients showed that the longer the time span between the moment of the trauma and the procedure, the higher the risk of complications and the conversion rate (21).…”

Section: Multiportal Vats Strategy: Basic Conceptsmentioning

confidence: 99%

Uniportal video-assisted thoracoscopic surgery in hemothorax

et al. 2017

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The management of hemothorax (spontaneous or, more often, due to thoracic trauma lesions), follows basic tenets well-respected by cardiothoracic surgeons. In most, a non-operative approach is adequate and safe, with a defined group of patients requiring only tube thoracostomy. Only a minority of patients need a surgical intervention due to retained hemothorax, persistent bleeding or incoming complications, as pleural empyema or entrapped lung. In the early 1990s, the rapid technological developments determined an increase of diagnostic and therapeutical indications for multiport video-assisted thoracoscopic surgery (VATS) as the gold standard therapy for retained and persistent hemothorax, allowing an earlier diagnosis, total clots removal and better tubes placement with less morbidity, reduced post-operative pain and shorter hospital stay. There is no consensus in the literature regarding the timing for draining hemothorax, but best results are obtained when the drainage is performed within the first 5 days after the onset. The traditional multiport approach has evolved in the last years into an uniportal approach that mimics open surgical vantage points utilizing a non-rib-spreading single small incision. Currently, in experienced hands, this technique is used for diagnostic and therapeutic interventions as hemothorax evacuation as like as the more complex procedures, such as lobectomies or bronchial sleeve and vascular reconstructions. visualization, a higher yield of detecting small injuries, less post-operative pain, improved lung function, shorter hospital stay and earlier recovery (2,5,7,8). KeywordsMore recently, the uniportal VATS approach has gained popularity in thoracic surgery, initially for minor procedures (9,10) and then also for major lung resection (11,12). This paper summarised recent advances available in the medical literature focusing especially on the VATS treatment of hemothorax, in particular considering the advantages of uniportal versus multiportal approach. Multiportal VATS strategy: basic conceptsThoracoscopy in the last years has been suggested as the first-line treatment in non-complicated hemothorax, leaving thoracotomy as the rescue option in case of failure or major trauma with bleeding (7). Truly, Joao Martins Castello Branco in 1946 was the first to describe the use of thoracoscopy in thoracic trauma, managing persistent bleeding with electrocoagulation. Since then, many authors described the use of this technique for diagnostic (diaphragmatic lesions) and therapeutic (hemothorax in penetrating chest trauma) options (13,14). However, only in the late 1990s, due to technical advances, its use became worldwide popular and VATS gained a primary position in the care of thoracic trauma patients (7,15). Villavicencio et al. (16) demonstrated that thoracoscopy may be used safely and successfully in assessment of clotted or persistent hemothorax and in empyema drainage; according to their data, 90-95% of patients with posttraumatic hemothorax are treated conservatively o...

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The Role of Thoracoscopy in the Management of Retained Thoracic Collections After Trauma

Cited by 131 publications

References 16 publications

Associated factors to empyema in post-traumatic hemotorax

Associated factors to empyema in post-traumatic hemotorax

Should videothorascopic surgery be the first choice in isolated traumatic hemothorax ? Prospective randomised controlled study

Uniportal video-assisted thoracoscopic surgery in hemothorax

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