The role of repairing lung lacerations during video-assisted thoracoscopic surgery evacuations for retained haemothorax caused by blunt chest trauma

Abstract

OBJECTIVESRetained haemothorax and pneumothorax are the most common complications after blunt chest traumas. Lung lacerations derived from fractures of the ribs are usually found in these patients. Video-assisted thoracoscopic surgery (VATS) is usually used as a routine procedure in the treatment of retained pleural collections. The objective of this study was to find out if there is any advantage in adding the procedure for repairing lacerated lungs during VATS.METHODSPatients who were brought to our hospital with blunt chest trauma were enrolled into this prospective cohort study from January 2004 to December 2011. All enrolled patients had rib fractures with type III lung lacerations diagnosed by CT scans. They sustained retained pleural collections and surgical drainage was indicated. On one group, only evacuation procedure by VATS was performed. On the other group, not only evacuations but also repair of lung injuries were performed. Patients with penetrating injury or blunt injury with massive bleeding, that required emergency thoracotomy, were excluded from the study, in addition to those with cardiovascular or oesophageal injuries.RESULTSDuring the study period, 88 patients who underwent thoracoscopy were enrolled. Among them, 43 patients undergoing the simple thoracoscopic evacuation method were stratified into Group 1. The remaining 45 patients who underwent thoracoscopic evacuation combined with resection of lung lacerations were stratified into Group 2. The rates of post-traumatic infection were higher in Group 1. The durations of chest-tube drainage and ventilator usage were shorter in Group 2, as were the lengths of patient intensive care unit stay and hospital stay.CONCLUSIONSWhen compared with simple thoracoscopic evacuation methods, repair and resection of the injured lungs combined may result in better clinical outcomes in patients who sustained blunt chest injuries.

Facilitating ventilator weaning through rib fixation combined with video-assisted thoracoscopic surgery in severe blunt chest injury with acute respiratory failure

“…All surgical procedures were performed in operating rooms, and patients were under general anesthesia. As per our other studies [14,15], in the VATS-only group, VATS was applied for the evacuation of residual blood clots and the resection of pulmonary lacerations under endoscopic visions. In patients who received rib fixation, VATS was also first used to treat the pleural and lung parenchyma lesions.…”

Efficiency Analysis of Direct Video-Assisted Thoracoscopic Surgery in Elderly Patients with Blunt Traumatic Hemothorax without an Initial Thoracostomy

“…Subsequently, the lung was reexpanded. Finally, 2 drainage tubes were fixed into the pleural cavity, and the patient was transferred to the trauma ICU for further postoperative care [ 17 , 18 ]. Following either procedure, the thoracostomy tubes were removed at the discretion of the thoracic surgeon when the drainage was <100 mL/24 h and no air leak was present.…”

The Effects of Add-on Self-Care Therapy on Epidural Catheter Analgesia and Quality of Life in Patients after Surgical Stabilization of Multiple Rib Fractures

“…VATS was employed after ORIF to assess screw penetration through the parietal pleura. A second VATS port was generated in the case of leakage of air through lung laceration for repair and resection using a linear cutter stapler [20]. Direct VATS visualization was utilized then to guide the chest tube placement.…”