THE ROLE OF THORACOSCOPY IN THE MANAGEMENT OF RETAINED THORACIC COLLECTIONS AFTER TRAUMA

Background. Retained hemothorax and infected thoracic collections afte r trauma can be seen in up to 20% of patients initially treated with t ube thoracostomy and have traditionally been treated nonoperatively, o ften with prolonged hospital stays. Methods. Twenty-five patients with retained thoracic collections were reviewed. They underwent 26 thorac escopies to evacuate undrained blood with or without infection. Result s. In 19 patients (76%), the collections were evacuated thoracoscopica lly. In 4 patients the procedure was converted to an open thoracotomy, and 2 patients required additional procedures to drain these collecti ons. Failure of thoracoscopy correlated with the time between injury a nd operation and the type of collection, but not with the mechanism of injury. When thoracoscopy was performed in less than 7 days after adm ission, no cases of empyema were noted at operation. Conclusions. Vide othoracoscopy is an accurate, safe, and reliable operative therapy to evacuate retained thoracic collections. In 90% of the patients in whom the procedure was completed, good results were obtained, reducing hos pital stay and possible complications. Videothoracoscopy should be the initial treatment in trauma patients with retained thoracic collectio ns and should be used earlier and more frequently in these patients. ( C) 1997 by The Society of Thoracic Surgeons.