World Journal of Surgery

, Volume 31, Issue 1, pp 19–25

Early Video-Assisted Thoracic Surgery for Primary Spontaneous Hemopneumothorax

  • Yu-Tang Chang
  • Zen-Kong Dai
  • Eing-Long Kao
  • Hung-Yi Chuang
  • Yu-Jen Cheng
  • Shah-Hwa Chou
  • Meei-Feng Huang
Article

Abstract

Introduction

Primary spontaneous hemopneumothorax (PSHP) is a rare surgical emergency. The aim of this study was to compare the previous strategy of tube thoracostomy followed by thoracotomy when complications developed with early video-assisted thoracic surgery (VATS) for PSHP.

Methods

Between November 1989 and May 2005, a total of 24 consecutive patients with PSHP were retrospectively reviewed. Before January 2000, there were 13 patients who were subjected to the treatment strategy of initial tube thoracostomy and underwent operation if the condition deteriorated or later complications occurred (group T). Under this strategy, all of these patients later required operations. After January 2000, another 11 patients were treated with VATS as soon as their condition stabilized after tube thoracostomy and resuscitation (group V). The data for the two groups were compared: sex, age, involved side, initial heart rate (HR) and mean blood pressure (BP), initial hemoglobin (Hb), preoperative blood loss, operating time, amount of blood transfusion, period of chest tube drainage (POD), length of hospital stay (LOS), complications, and length of follow-up.

Results

The sex, age, involved side, and the initial HR, BP, and Hb of the two groups were similar. The patients of group V had a significantly longer operating time [group V, 111 minutes (mean); group T, 85 minutes, P = 0.002]; less preoperative blood loss (group V, 946 ml; group T, 1687 ml, P = 0.003); less blood transfusion (group V, 465 ml; group T, 1044 ml, P = 0.002); shorter POD (group V, 4 days; group T, 7 days, P = 0.011); and shorter LOS (group V, 5 days; group T, 10 days, P = 0.002). No mortality or recurrence was noted in the entire series.

Conclusions

Our study suggests that surgery should be undertaken for PSHP as soon as possible after the clinical condition has stabilized. Under this strategy, VATS is an acceptable approach. It allows a shorter hospital stay and is exempt from unnecessary blood transfusion. Later complications, such as empyema and impaired lung reexpansion, can also be avoided.

References

  1. 1.
    Tatebe S, Kanazawa H, Yamazaki Y, et al. Spontaneous hemopneumothorax. Ann Thorac Surg 1996;62:1011–1015PubMedCrossRefGoogle Scholar
  2. 2.
    Muraguchi T, Tsukioka K, Hirata S, et al. Spontaneous hemopneumothorax with aberrant vessels found to be the source of bleeding: report of two cases. Surg Today 1993;23:1119–1123PubMedCrossRefGoogle Scholar
  3. 3.
    Sharpe DA, Dixon K, Moghissi K. Spontaneous haemopneumothorax: a surgical emergency. Eur Respir J 1995;8:1611–1612PubMedGoogle Scholar
  4. 4.
    Hsu NY, Hsieh MJ, Liu HP, et al. Video-assisted thoracoscopic surgery for spontaneous hemopneumothorax. World J Surg 1998;22:23–27PubMedCrossRefGoogle Scholar
  5. 5.
    Kakaris S, Athanassiadi K, Vassilikos K, et al. Spontaneous hemopneumothorax: a rare but life-threatening entity. Eur J Cardiothorac Surg 2004;25:856–858PubMedCrossRefGoogle Scholar
  6. 6.
    Wu YC, Lu MS, Yeh CH, et al. Justifying video-assisted thoracoscopic surgery for spontaneous hemopneumothorax. Chest 2002;122:1844–1847PubMedCrossRefGoogle Scholar
  7. 7.
    Ohmori K, Ohata M, Narata M, et al. 28 Cases of spontaneous hemopneumothorax. J Jpn Assoc Thorac Surg 1988;36:1059–1064Google Scholar
  8. 8.
    Kurimoto Y, Hatamoto K, Hase M, et al. Aberrant artery as a source of bleeding in spontaneous hemopneumothorax. Am J Emerg Med 2001;19:326–327PubMedCrossRefGoogle Scholar
  9. 9.
    Hwong TM, Ng CS, Lee TW, et al. Video-assisted thoracoscopic surgery for primary spontaneous hemopneumothorax. Eur J Cardiothorac Surg 2004;26:893–896PubMedCrossRefGoogle Scholar
  10. 10.
    Chiang WC, Chen WJ, Chang KJ, et al. Spontaneous hemopneumothorax: an overlooked life-threatening condition. Am J Emerg Med 2003;21:343–345PubMedCrossRefGoogle Scholar
  11. 11.
    Tatebe S, Yoshiya K, Yamaguchi A. Video-assisted thoracoscopic surgery for spontaneous hemopneumothorax. Surg Laparosc Endosc 1997;7:113–115PubMedCrossRefGoogle Scholar
  12. 12.
    Chou SH, Cheng YJ, Kao EL, et al. Spontaneous haemothorax: an unusual presentation of primary lung cancer. Thorax 1993;48:1185–1186PubMedGoogle Scholar
  13. 13.
    Lee SC, Cheng YL, Yu CP. Haemopneumothorax from congenital cystic adenomatoid malformation in a cryptorchidism patient. Eur Respir J 2000;15:430–432PubMedCrossRefGoogle Scholar
  14. 14.
    Martinez FJ, Villanueva AG, Pickering R, et al. Spontaneous hemothorax: report of 6 cases and review of the literature. Medicine 1992;71:354–368PubMedCrossRefGoogle Scholar
  15. 15.
    Liman ST, Kuzucu A, Tastepe AI, et al. Chest injury due to blunt trauma. Eur J Cardiothorac Surg 2003;23:374–378PubMedCrossRefGoogle Scholar
  16. 16.
    Galan G, Penalver JC, Paris F, et al. Blunt chest injuries in 1696 patients. Eur J Cardiothorac Surg 1992;6:284–287PubMedCrossRefGoogle Scholar
  17. 17.
    de Perrot M, Deleaval J, Robert J, et al. Spontaneous hemopneumothorax—results of conservative treatment. Swiss Surg 2000;6:62–64PubMedCrossRefGoogle Scholar
  18. 18.
    Haciibrahimoglu G, Cansever L, Kocaturk CI, et al. Spontaneous hemopneumothorax: is conservative treatment enough? Thorac Cardiovasc Surg 2005;53:240–242PubMedCrossRefGoogle Scholar
  19. 19.
    Hentel K, Brill PW, Winchester P. Spontaneous hemopneumothorax. Pediatr Radiol 2002;32:457–459PubMedCrossRefGoogle Scholar
  20. 20.
    Hart SR, Willis C, Thorn A, et al. Spontaneous haemopneumothorax: are guidelines overdue? Emerg Med J 2002;19:273–274PubMedCrossRefGoogle Scholar
  21. 21.
    Schramel FM, Postmus PE, Vanderschueren RG. Current aspects of spontaneous pneumothorax. Eur Respir J 1997;10:1372–1379PubMedCrossRefGoogle Scholar
  22. 22.
    Waller DA, Forty J, Morritt GN. Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax. Ann Thorac Surg 1994;58:372–377PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Yu-Tang Chang
    • 1
  • Zen-Kong Dai
    • 2
    • 4
  • Eing-Long Kao
    • 1
    • 4
  • Hung-Yi Chuang
    • 3
    • 4
  • Yu-Jen Cheng
    • 1
    • 4
  • Shah-Hwa Chou
    • 1
    • 4
  • Meei-Feng Huang
    • 1
  1. 1.Department of SurgeryKaohsiung Medical University HospitalKaohsiungTaiwan
  2. 2.Department of PediatricsKaohsiung Medical University HospitalKaohsiungTaiwan
  3. 3.Department of Occupational MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
  4. 4.Faculty of Medical School, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan

Personalised recommendations