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OBJECTIVE: Primary spontaneous hemopneumothorax (PSHP) is a surgical emergency. This study was to compare early video-assisted thoracic surgery (VATS) with the more conservative strategy of tube thoracostomy followed by thoracotomy when complications developed for PSHP.
METHODS: Between October 1988 and July 2006, a total of 27 consecutive patients with PSHP were retrospectively studied. Before January 2000, there were 14 patients subjected to the treatment strategy of initial tube thoracostomy and underwent operation if the condition deteriorated or later complications occurred (group C). Finally, all patients later required operations. After January 2000, another 13 patients were treated with VATS as soon as their condition stabilized after tube thoracostomy and resuscitation (group T). The two groups were compared: sex, age, involved side, initial heart rate (HR) and mean blood pressure (BP), initial hemoglobin (Hb), chest tube amount on insertion, operation time, amount of blood transfusion, period of chest tube drainage (POD), length of hospital stay (LOS), complications, and length of follow-up.
RESULTS: The patients of group T had a significantly longer operation time [group T, 114 minutes (mean);group C, 83 minutes P=0.018]; less preoperative blood loss (group T, 957ml; group C, 1664ml, P=0.004); less blood transfusion (group T, 448ml; group C, 1023ml, P=0.0017); shorter POD (group T, 4 days; group C, 7 days, P=0.012); and shorter LOS (group T, 5 days; group C, 10 days, P=0.0019). No mortality or recurrence was noted in the entire series.
CONCLUSIONS: By conservative strategy, no patient was exempted from surgical intervention. According to our study results, patients were benefited with early VATS which should be performed as soon as their condition stabilized.