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Ann Thorac Surg 1985;40:542-545
© 1985 The Society of Thoracic Surgeons

Articles

Current Concepts in the Management of Postoperative Chylothorax

Mark K. Ferguson, M.D.*, Alex G. Little, M.D., David B. Skinner, M.D.

From the Department of Surgery, The University of Chicago Hospitals and Clinics and the Pritzker School of Medicine, Chicago, IL

Accepted for publication February 9, 1985.

* Address reprint requests to Dr. Ferguson, Department of Surgery, Box 255, The University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637

Thirteen patients required pleural drainage for postoperative chylothorax with an average duration of leakage of 36.9 days. Total protein and albumin levels, body weight, and peripheral lymphocyte counts all decreased substantially during the period of chylous leakage. Only 3 chylothoraces resolved with tube drainage and dietary management alone. Six patients required eight operations for control of chylothorax, and 4 patients, all of whom had cancer, died with a persistent leak.

Chylothorax is a debilitating postoperative complication resulting in an impaired immune system and nutritional state. Because it is associated with a 50% mortality in patients with cancer, early reoperation should be considered. Patients with benign underlying disease can be managed conservatively for longer periods. Control of potential chylous leaks at the time of original operation is vital, especially in patients with malignancies who have a predisposition toward leakage from sites other than the main thoracic duct.




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