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Ann Thorac Surg 2001;71:448-450
© 2001 The Society of Thoracic Surgeons

Original article: general thoracic

Current management of postoperative chylothorax

Hossein Fahimi, MDa, Filip P. Casselman, MDa, Massimo A. Mariani, PhDa, Wim J. van Boven, MDa, Paul J. Knaepen, MDa, Henry A. van Swieten, PhDa

a Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands

Accepted for publication May 20, 2000.

Address reprint requests to Dr van Swieten, Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
e-mail: hauswie{at}knmg.nl

Background. This study was performed to review our experience with postoperative chylothorax and describe our current approach. In addition, we wanted to estimate the impact of video-assisted thoracoscopic surgery (VATS) on our current management policy.

Methods. From January 1991 to December 1999, 12 patients developed chylothorax after various thoracic procedures. Their mean age was 61.5 (range 31 to 80 years). The procedures were cardiac, aortic, and pulmonary operations.

Results. All patients were initially treated conservatively. In addition, 7 patients needed surgical intervention, including one thoracotomy and six VATS. The site of thoracic duct laceration was identified and treated with VATS in 4 patients. In 2 patients, the leak could not be localized by VATS, and fibrin glue or talcage were applied in the pleural space. All patients were discharged without recurrent chylothorax.

Conclusions. VATS is an effective tool in the management of persisting postoperative chylothorax. Its easy use, low cost, and low morbidity rate suggest an earlier use of VATS in the treatment of postoperative chylothorax.


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Invited commentary
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Ann. Thorac. Surg. 2001 71: 450-451. [Extract] [Full Text] [PDF]



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