Current Thoracic Surgery 2021 , Vol 6 , Issue 2
Comparing the outcomes of video-assisted thoracoscopic surgery and rethoracotomy in the management of postoperative hemorrhage
Volkan Erdoğu1,Meral Selin Onay1,Ayşegül Çiftçi1,Ece Yasemin Emetli1,Semih Erduhan1,Atilla Pekçolaklar2,Mustafa Vedat Doğru1,Yunus Aksoy1,Ali Cevat Kutluk1,Muzaffer Metin1
1Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
2Department of Thoracic Surgery, Bursa City Hospital, Bursa, Turkey
DOI : 10.26663/cts.2021.0010 Viewed : 396 - Downloaded : 249 Background: Although postoperative hemorrhage after thoracic surgery is uncommon, it is the most common indication for revision surgery after these procedures. Most postoperative hemorrhages are due to surgical technique, although some comorbidities can predispose the patient to bleeding. We investigated whether video-assisted thoracoscopic surgery (VATS) and re-thoracotomy had the same outcomes in the management of postoperative hemorrhage in patients who underwent open thoracotomy or VATS.

Materials and Methods: We retrospectively analyzed patients with postoperative hemorrhage after thoracotomy (n = 659) or VATS (n = 883) between 2018 and 2020. Revision surgery was performed after thoracotomy in 22 patients (3.3%) and after VATS in 4 patients (0.4%). Of these, 11 patients (42.3%) were re-operated by re-thoracotomy (Re-thoracotomy Group) and 15 patients (57.7%) by revision VATS (VATS Group).

Results: Revision due to postoperative hemorrhage was required significantly more frequently after thoracotomy than VATS (3.3% vs. 0.4%, p < 0.001). In patients with hemorrhage after pneumonectomy (n = 14), revision by VATS was preferred to re-thoracotomy (n = 10, 71.4% vs. n = 4, 28.6%). The mean time to discharge after revision surgery was 5.1 ± 2.2 days (range, 2-12 days) overall and was significantly shorter in the revision VATS Group than in the Re-thoracotomy Group (4.4 ± 1.5 days vs. 6.2 ± 2.5 days, p = 0.004).

Conclusions: VATS has similar results to re-thoracotomy and is advantageous in terms of earlier recovery and shorter hospital stay. Therefore, VATS should be the preferred method for postoperative hemorrhage management. Keywords : VATS, re-operation, thoracic surgery, thoracotomy, postoperative hemorrhage