THORACOSCOPY IN THE MANAGEMENT OF POSTTRAUMATIC PERSISTENT PNEUMOTHORAX

Background: Persistent posttraumatic pneumothorax (PPP) is an uncommon complication of traumatic injuries of the chest, usually managed with suction drainage and involving prolonged hospital stays. This study w as conducted to assess the advantages of using video-assisted thoracos copic surgery (VATS) in the management of patients,vith PPP. Study Des ign: Eleven patients with PPP underwent VATS for diagnosis and for def initive treatment. Results: Before VATS was done, all patients had und ergone multiple attempts to resolve the PPP; the hospital stay before VATS was 10 days (range, 4-14 days). In 10 patients, the cause of the PPP was identified and a segmental stapled resection mas performed, wi th complete success in resolving the air leak and obtaining pleural sy nthesis. In another patient, the source of the air leak was not identi fied and a thoracoscopically assisted chemical pleurodesis was perform ed, with immediate cessation of the air leak All chest tubes were remo ved within 48 hours of the procedure; 9 patients were discharged withi n 72 hours of VATS. Preoperative computed tomography of the chest was useful in 2, patients, but bronchoscopy did not disclose any major air way injury. Conclusions: Videothoracoscopy is an accurate, safe, and r eliable alternative to an open thoracotomy in the management of patien ts with PPP. In the patients in whom the procedure tvas completed, exc ellent results were obtained and the hospital stay was reduced. We bel ieve that VATS should be used earlier and more frequently after failur e of conservative management in such patients. (C) 1998 by the America n College of Surgeons.