Background: Chest trauma complicated with hemothorax is increasing nowadays either secondary to road traffic accidents (RTA) or chest trauma especially if associated with fractures ribs or sternum. Hemothorax is the presence of blood in the pleural space. clotted hemothorax is a serious problem associated with the presence of fluid loculation by fibrous adhesions, trapped lungs and increased the risk of developing empyema. Insertion of chest drain is the classic primary management modality in most of the cases. Nowadays video- assisted thoracoscopic surgery (VATS) is the corner stone in management of clotted hemothorax. Our objective is to assess the surgical outcome of early intervention using VATS compared to conventional thoracotomy in treatment of post traumatic retained hemothorax. Patient and method: our study is a retrospective single blinded study included 120 patients with post traumatic clotted hemothorax randomly divided into 2 groups: Group I: include 60 patients who were operated through thoracotomy and group II: include 60 patients who were operated through VATS. Result: The study showed that group I had longer postoperative period to return to normal activity (2-3) weeks on the other hand group II it was (1-2) weeks, with significant difference between both groups (P = 0.01).
Conclusion:
VATS is the treatment of choice for traumatic hemothorax rather than conventional thoracotomy as it is less invasive, smaller surgical wound and allow early evacuation of retained hemothorax, minimizing or preventing complications with better patient satisfaction.

KEYWORDS: Clotted hemothorax, VATS, thoracotomy.