A retrospective review of the management and outcome of patients with retained intrathoracic foreign bodies

Abstract

Background: Minimally invasive surgery has transformed surgery. Video-assisted thoracoscopic surgery (VATS) has been used for a few specific acute indications, however there is a paucity of data describing the management of intrathoracic foreign body removal compared to open thoracotomy.

Method: A retrospective observational chart review of patients requiring surgical management of retained intrathoracic FB during the period of January 2005 to December 2021 at Inkosi Albert Luthuli Central Hospital was undertaken. This was approved as a sub-study of BCA207-09 by the UZKN BREC.

Results: Forty-two patients were identified. Sixteen (38%) were paediatric patients and 26 (62%) adults, with average age of 24 years (6 months–69 years) and a male predominance (78.6%). VATS was used initially in 33 patients, successfully in 11 (26%) and 12 (28%) required conversion to thoracotomy, while in 15 (36%) a thoracotomy was the initial procedure. Four (10%) required other surgical options. Median hospital stay was 7 days. Fourteen patients required postoperative ICU admission, 50% being those post-aspiration injury. Mechanistically, 13 were FB aspiration (31%), 25 trauma (60%) and 4 iatrogenic (9%) causes. Aspiration occurred only in paediatric patients. Among the trauma patients, 23 were adult and 2 paediatric. These included 12 retained knife blades, eight with bullets or bullet fragments in situ, 1 nail and 2 sewing needles. Of these, 8 were managed successfully with VATS (1 bullet and 7 knife blade extractions) and 12 required conversion to thoracotomy or sternotomy. Both paediatric patients with sewing needle FB required thoracotomy. Regarding the iatrogenic FB, two Malecot^® drains were removed with VATS and one patient required bilateral thoracotomies for removal of intercostal drain caps.

Conclusion: Approximately 25% of all intrathoracic retained FB can be successfully removed by VATS, while many still require thoracotomy. Most patients will recover without sequelae.