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The Annals of Thoracic Surgery, Vol 57, 1507-1511, Copyright © 1994 by The Society of Thoracic Surgeons
DD Graham, ED McGahren, CG Tribble, TM Daniel and BM Rodgers
Chylothorax, a potentially lethal disorder that may cause profound
respiratory, nutritional, and immunologic complications, has become
increasingly common in recent years. Medical therapy has been found to have
a significant failure rate. Therefore, surgical treatment of complicated
chylothorax has become a mainstay of care. Between 1987 and 1993, ten
patients at the University of Virginia Hospital were treated with
video-assisted thoracic surgery for complicated chylothorax. Twelve
thoracoscopic procedures were performed. Patients ranged in age from 7
months to 82 years. Causes included iatrogenic (2), congenital (2), caval
thrombosis (2), amyloid (2), blunt trauma (1), and metastatic carcinoid
tumor (1). In 10 cases, video-assisted thoracic surgery was employed as the
principal mode of therapy: 8 using talc pleurodesis alone, 1 using talc
pleurodesis and clipping of the thoracic duct with application of fibrin
glue, and 1 requiring clipping of a pleural defect with application of
fibrin glue. In 2 cases, a video-assisted thoracic operation was used in
conjunction with pleuroperitoneal shunting: a previously placed
pleuroperitoneal shunt that was malfunctioning was repositioned
thoracoscopically after a pleural adhesiolysis, and a pleural adhesiolysis
was performed thoracoscopically before placement of a pleuroperitoneal
shunt. In all cases the effusion resolved after the video-assisted thoracic
operation without further intervention. Video-assisted thoracic surgery
offers an effective means of treating chylothorax, regardless of cause,
allowing the advantage of access to thoracic structures without the
morbidity of more extensive procedures.
ARTICLES
Use of video-assisted thoracic surgery in the treatment of chylothorax
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908.
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