الفهرس 
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Abstract
Chest injuries occur in approximately 60% of trauma patients, with hemothorax or hemopneumothorax occurring in almost a third of these patients. Hemothorax should be suspected based on mechanism of injury, physiologic parameters, and physical exam findings. Retained hemothorax is defined as residual clots at least 500 ml, or at least one-third of the blood in the pleural space cannot be drained by a chest tube after 72 h of initial treatment revealed by a computed tomography scan. Retained hemothorax is a known sequelae of traumatic hemothorax and its incidence ranging from 4% to 20% and is associated with significant morbidity as well as increased costs and burden to the healthcare system. Early evacuation of hemothorax by the intercostal tube is an important step in management of hemothorax to avoid development of fibrous adhesion or empyema. Open thoracotomy is a major surgical procedure in the management of retained hemothorax. The operative incision by itself carries a prolonged recovery period even in cases with mild intrathoracic injury. The reported incidence of chronic post thoracotomy pain syndrome is 5% to 25%. Video-assisted thoracoscopic surgery (VATS) has become a popular method in diagnosis and treatment of acute chest injuries. Except for patients with unstable vital signs who require larger surgical incisions to check bleeding, this endoscopic surgery could be employed in the majority of thoracic injury patients with stable vital signs so early VATS intervention after injury can decrease the rate of posttraumatic infection and length of hospital stay.Providing the advantages of minimally invasive surgery, VATS has gained an increasing importance as a diagnostic and therapeutic tool in chest trauma. Its indications, feasibility, and safety have been investigated and demonstrated good results. This study aimed to compare effectiveness of VATS versus open thoracotomy in management of posttraumatic retained clotted hemothorax. This prospective randomized study was conducted on 60 patients with posttraumatic residual clots at least 500 ml, or at least one-third of the blood in the pleural space cannot be drained by a chest tube after 72 h of initial treatment revealed by a computed tomography scan. Patients were divided equally into two groups: • group A: patients underwent VATS. • group B: patients underwent open thoracotomy. Summary of our results • Demographic characteristics (Age, sex, BMI, temperature) were insignificantly different between both groups. • The type of trauma and side of affection were insignificantly different between both groups. • Duration of operation was significantly lower in VATS group compared to open thoracotomy group (P value <0.001). • Operation findings and postoperative ventilation time were comparable between both groups (P value = 0.681, and 0.142 respectively)Numeric rating scale was significantly different between both groups. NRS was better in VATS group compared to open thoracotomy group (P value <0.001). • The amount of postoperative ICT drainage ranged from 50 – 100 with a mean of 83.33±30.32 in VATS group and ranged from 100– 200 with a mean(±SD) of 153.33±47.22 in open thoracotomy group. ICT drainage removal ranged from 1 – 2 days with a mean of 1.4 ± 0.5 days in VATS group and ranged from 2 – 4 days with a mean of 2.8 ± 0.83 days in open thoracotomy group. • Postoperative ICT drainage and duration of ICT drainage were significantly lower in VATS group compared to open thoracotomy group (P value <0.001). • Wound infection occurred in 1 (3.33%) patient in VATS group and in 8 (26.67%) patients in open thoracotomy group. • Air leak occurred in 1 (3.33%) patient in group A and in 3 (10%) patients in open thoracotomy group, but it wasn’t persistent air leak, it was just in day zero and relieved by good chest physiotherapy. • The incidence of wound infection was significantly lower in VATS group compared to open thoracotomy group (P value=0.025); The incidence of air leak was insignificantly different between both groups. • Hospital stay was significantly lower in VATS group compared to group B (P value <0.001). Patients in VATS group returned to the normal activity earlier than open thoracotomy group (P value <0.001).Wound infection in follow up outpatients was insignificant different between both groups (P value =0.492). • Patients in group A returned to the normal activity earlier than group B (P value <0.001).