Treatment Of Postoperative Chylothorax Research Articles

Coil or Plug-Assisted Ethylene Vinyl Alcohol Copolymer (EVOH) Thoracic Duct Embolization in the Treatment of Postoperative Chylothorax

Eleven patients (5 men, 6 women) with post-operative thoracic duct injuries and high output chylothorax were treated with thoracic duct embolization (TDE). Six patients underwent intraprocedural thoracic duct ligation at the time of original procedure. In all cases, the pleural fluid demonstrated high triglyceride levels (414 mg/dL; interquartile range [IQR], 345 mg/dL). Median daily (IQR) chest tube outputs before and after TDE were 900 mL (1,200 mL) and 325 mL (630 mL), respectively. Coil- or plug-assisted ethylene vinyl alcohol (EVOH) copolymer was used as embolic agent in all patients. Technical and clinical success rates were 100% and 82%, respectively. Nontarget venous embolization of EVOH copolymer was not identified on subsequent imaging.

Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax.

Objective: To preliminarily explore the safety and effectiveness of transpedal lymphangiography (TL) with high-dose ethiodized oil application (>20 ml) in the treatment of high-output postoperative chylothorax.Methods: From 1 July 2020 to 1 July 2021, a total of 7 patients with high-flow postoperative chylothorax (> 1,000 ml/d) were retrospectively reviewed in a single center. Clinical data, including surgery types, technical and treatment success of TL, and adverse events of TL, were collected and analyzed.Results: Seven patients (5 cases of non-small cell lung cancer; 2 cases of esophageal carcinoma) with a median age of 62 years (range: 30–70 years) occurred postoperative chylothorax after tumor resection with mediastinal lymphadenectomy. All patients received conservative treatment including total parenteral nutrition and somatostatin administration for a median of 20 days (range: 15–31 days) that failed to cure the chylothorax, so TL was performed as a salvage. Before TL, the median daily chyle output was 1,500 ml/day (range: 1,100–2,000 ml/day). The technical success rate of TL was 100% (7/7), with the median volume of ethiodized oil of 27.6 ml (range: 21.2–30.0 ml) injected in TL. Ruptured thoracic duct was identified in 5 patients (5/7, 71%) in fluoroscopy and chest CT after TL. The treatment success rate of TL was 86% (6/7). In 6 patients, the thoracic drainage was removed after a median of 7 days (range: 4–13 days) from TL performance. No adverse event of TL was reported.Conclusion: Transpedal lymphangiography with high-dose ethiodized oil application (>20 ml) is a feasible, safe, and effective modality for the treatment of high-flow (> 1,000 ml/day) postoperative chylothorax.

Posterior retroperitoneoscopic thoracic duct ligation: a novel surgical approach.

Treatment of postoperative chylothorax can be challenging. Conservative treatment and/or surgical management by means of open or minimally invasive thoracic duct ligation for persistent chylothorax are accepted therapeutic options. We present a new retroperitoneoscopic approach for thoracic duct ligation. Between January 2006 and May 2017, posterior retroperitoneoscopic thoracic duct ligation was performed in four patients. The thoracic duct was identified transdiaphragmatically and ligated cranially to the cisterna chyli using absorbable clips. Retroperitoneoscopic ligation resulted in a complete and lasting chylothorax resolution in three patients and marked improvement in a fourth one. Mean operative time was 86min (range 40-135). There were no perioperative or postoperative complications. Retroperitoneoscopic thoracic duct ligation is feasible and safe. It allows for a precise anatomical exploration of the thoracic duct caudally to the chyle leak, avoiding the previous operative field and resulting in minimal morbidity. In patients with persistent chylothorax, our approach provides an additional therapeutic option.

The use of indocyanine green lymphography for the treatment of postoperative chylothorax with lipiodol lymphangiography in a 2-year-old child

Abstract Postoperative chylothorax in infants prolongs hospital stay and possibly causes developmental delay because of its conservative treatment including inanition. Several medical and surgical treatments may be applied, but none constitute the absolute solution. Treatment with lipiodol during lymphangiography for postoperative chylothorax has been reported to be highly effective and less invasive in adults. On the other hand, few cases have been reported in infants. We demonstrate successful blockage of chyle leakage with lipiodol injection through the inguinal lymph node in a 2-year-old infant. The patient had undergone on-pump coarctectomy and chylothorax developed soon after surgery. Several medical treatments were partially effective, but the chest tube could not be removed because sequential aspiration was required to maintain a normal respiratory status. With the patient under general anesthesia, lipiodol injection combined with indocyanine green (ICG) lymphography was performed. Lymphography combined with ICG significantly contributed not only to intraoperative detection of the inguinal lymph nodes but also to postoperative early detection of lymphedema caused by this procedure. This procedure required a simple maneuver and is probably applicable to other cases of traumatic chylothorax, such as after surgeries on the esophagus, trachea, or other components of the posterior mediastinum.

Algorithm of diagnosis and surgical treatment of postoperative chylothorax

Algorithm of diagnosis and surgical treatment of postoperative chylothorax

Application of somatostatin in expectant treatment for postoperative chylothorax in children after congenital heart disease surgery

Objective To investigate the therapeutic efficacy of somatostatin on chylothorax after congenital heart disease surgery in children. Methods Retrospective analysis was performed in 13 postoperative chylothorax cases from Jan.2003 to Dec.2012, who were divided into control group (n=6) and treatment group(n=7), and there was no significant difference in age, weight, and time of occurrence between the 2 groups.The diagnosis standard for chylothorax was the same.The changes of chylous volume during the treatment were analyzed between 2 groups, and healing time and other data were analyzed too. Results Control group: clinical cure in 3 cases, conservative treatment failed in 3 cases(2 cases recovered after operation and 1 case died). The chyle volume of control group reduced obviously compared with post treatment from beginning [(256.6±124.2) mL/d]to 1 week[(155.5±85.7) mL/d] and 2 weeks[(142.3±110.3) mL/d] later( t=4.623, 2.099; P=0.002, 0.044). But it did not reduce obviously in 3 weeks later[(139.4±113.4) mL/d](t=1.745, P=0.07). Treatment group: 6 cases in treatment group were successful in recovery after conservative treatment and 1 case underwent operation.The chyle volume of treatment group reduced obviously compared with post treatment from beginning to 1 week [(51.2±18.7) mL/d]and 2 weeks [(19.3±7.05) mL/d]later ( t=5.549, 6.638; P=0.001, 0.001). Compared with the control group, the difference between 2 groups in post treatment(1 week later, 2 weeks later) was of statistical significance(t=2.900, 2.412; P=0.014, 0.034). The healing time of conservative treatment in 2 groups(only for recovery) had obvious difference[(32.8±1.8) d, (25.2±1.7) d](t=2.512, P=0.028). Conclusions The use of somatostatin can significantly promote the recovery of chylothorax in children, and it should be actively used in early conservative treatment. Key words: Somatostatin; Chylothorax; Congenital heart disease; Thoracic duct ligation; Child

Radiotherapy in the treatment of postoperative chylothorax

BackgroundChylothorax is characterized by the presence of chyle in the pleural cavity. The healing rate of non-operative treatment varies enormously; the maximum success rate in series is 70%. We investigate the efficacy and outcomes of radiotherapy for postoperative chylothorax.MethodsChylothorax was identified based on the quantity and quality of the drainage fluid. Radiation was indicated if the daily chyle flow exceeded 450 ml after complete cessation of oral intake. Radiotherapy consisted of opposed isocentric portals to the mediastinum using 15 MV photon beams from a linear accelerator, a single dose of 1–1.5 Gy, and a maximum of five fractions per week. The radiation target area was the anatomical region between TH3 and TH10 depending on the localization of the resected lobe. The mean doses of the ionizing energy was 8.5 Gy ± 3.5 Gy.ResultsThe median start date of the radiation was the fourth day after chylothorax diagnosis. The patients’ mediastinum was radiated an average of six times. Radiotherapy, in combination with dietary restrictions, was successful in all patients. The median time between the end of the radiation and the removal of the chest tube was one day. One patient underwent wound healing by secondary intention. The median time between the end of radiation and discharge was three days, and the overall hospital stay between the chylothorax diagnosis and discharge was 18 days (range: 11–30 days). After a follow-up of six months, no patient experienced chylothorax recurrence.ConclusionsOur results suggest that radiotherapy in combination with dietary restriction in the treatment of postoperative chylothorax is very safe, rapid and successful. This novel interventional procedure can obviate repeat major thoracic surgery and shorten hospital stays and could be the first choice in the treatment of postthoracotomy chylothorax.

Etilefrine投与が有効であった食道癌術後難治性乳縻胸の1例

症例は75歳の男性で，胸部食道癌T3N2M0 cStage IIIに対し，術前化学放射線療法施行後，食道癌根治術を行った．経口摂取開始後よりドレーン排液の白濁を認め，乳縻胸と診断した．絶食，TPN管理を開始し， lipiodolリンパ管造影，再開胸下での胸管結紮術，octreotide acetate投与を試みるも，排液量減少は得られなかった．第30病日よりetilefrine投与を開始すると徐々に排液量は減少し，第55病日に胸腔ドレーンを抜去した．Etilefrine投与中止後も胸水増加は認めなかった．食道癌術後合併症として乳縻胸の発生はまれであるが，確実な治療法がなく，治療に難渋することが少なくない．今回，我々はetilefrine投与によって治癒した症例を経験した．術後難治性乳縻胸に対するetilefrine投与は，本邦での過去の報告例はなく，試みられるべき効果的な治療法と考えられた．

Fístula linfática após tratamento cirúrgico de síndrome do desfiladeiro torácico à direita

Chylothorax as a complication of the surgical treatment of thoracic outlet syndrome is a quite rare event. We report a case of right-sided chylothorax and present a brief review on the treatment of postoperative chylothorax.

The effectiveness of octreotide in the treatment of post-operative chylothorax.

Chylothorax may be spontaneous or a complication of thoracic surgery. Treatment of this potentially harmful condition is not well established and may comprise dietary interventions and surgery. Somatostatin seems effective in the management of chylothorax, although its mechanism of action is unclear. octreotide, a somatostatin analogue, may be effective in the treatment of post-operative chylothorax.

Current management of postoperative chylothorax

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.

Ligation of the thoracic duct without thoractomy as an effective treatment for postoperative chylothorax: A newly designed surgical procedure

We describe herein a newly designed surgical procedure for ligating the thoracic duct to treat postoperative chylothorax, without performing a thoracotomy. This technique was successfully performed on a 50-year-old man who developed chylothorax following resection of carcinoma of the esophagus whose case is briefly presented. The advantages of this procedure include the following: the integrity of the thorax is maintained, there is less traumatization, the need for a drainage tube is eliminated, shorter hospitalization is required, and the thoracic duct is much more easily exposed than by conventional transthoracic approaches. No similar report was found in our research of the literature.

Treatment of postoperative chylothorax by fibrin glue application under thoracoscopic view with use of local anesthesia

Treatment of postoperative chylothorax by fibrin glue application under thoracoscopic view with use of local anesthesia

Treatment of postoperative chylothorax with intrapleural fibrin glue

Two patients with chylothorax after pulmonary resection for lung cancer were successfully treated without thoracotomy by injection oi fibrin glue components into the pleural cavity. This new technique for closing the chylous leak is described.