Chylothorax - Modalities of management and outcomes

Abstract

Background:At present, there are no universally accepted protocols for the management of chylothorax. This study aims at reporting the clinical experience and presenting our institutional protocol for managing chylothorax.Materials and Methods:This is a retrospective analysis of chylothorax patients managed at a dedicated thoracic surgical unit over 8 years. A detailed analysis of demography and perioperative variables including complications was carried out. Factors influencing failure of conservative and surgical therapy were analyzed.Results:A total of 26 patients were included with a mean age of 42.4 years (range, 2–72 years). Postsurgical chylothorax was the most common variant (53.8%). Majority (46.1%) of the patients had >1000 ml/24 h intercostal tube drainage at presentation. All patients were initially subjected to conservative management, of which 11 (42.4%) patients were managed successfully with conservative therapy alone. Rest 15 (57.6%) patients required video-assisted thoracoscopic thoracic duct ligation, which was successful in 10/15 (66.7%) patients, whereas additional intervention was required in 5/15 (33.3%) patients. Drain output of >1000 ml/day was an independent predictor of failure of conservative therapy. Nontraumatic bilateral chylothorax was associated with high probability of failure of surgical therapy in the first attempt and may require additional treatment modality.Conclusions:Initial conservative management is recommended for all chylothorax patients, which is unlikely to succeed if daily drainage is >1000 ml/24 h. VATS thoracic duct ligation is recommended in such cases. Nontraumatic bilateral chylothorax has higher surgical failure rates. In such cases, additional procedures in the form of pleurodesis and/or thoracic duct embolization/disruption should be considered.