Diaphragmatic Fenestration for Resistant Pleural Effusions After Univentricular Palliation

Abstract

In patients with persistent pleural effusions following univentricular palliation, DF is an attractive option when conventional therapies have failed. This original technique of DF is simple, reproducible, cost-effective, and free of any known complications.

Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

“…10 Its efficacy in reducing the volume of daily pleural effluent as well as the number of days required for chest drainage has been demonstrated. 5,7 As in patient, there was quick return to enteral feeding after diaphragmatic fenestration. The fenestrations in the patch allow adequate drainage of pleural fluid into the peritoneal cavity reducing the chance of infection and occlusion a problem noted to occur with the use of pleuroperitoneal shunts, while preventing herniation of intraabdominal content.…”

“…3,4 This does not address the ooze of lymphatic fluid from the lung parenchyma. 7 Some authors have employed the use of pleurodesis and pleurectomy to obliterate the pleural space to mitigate this. The attendant pain and limitation in pulmonary function makes this option not optimal.…”

“…Bilateral diaphragmatic fenestration has been described in some reports however right sided diaphragmatic fenestration alone has been found to effectively treat chylothorax on the left side too. 5,7 Potential complications of diaphragmatic fenestration are respiratory compromise from impaired diaphragmatic function and an increase in abdominal girth signifying chylous ascites. No report of such was noted in the literature nor in the presented case.…”

“…Methods employed include fasting, use of medium chain triglyceride/ low fat feeds, total parenteral nutrition, and octreotide therapy. 2,3,7,8 Less invasive surgical options include periodic pleural aspirations and intercostal drainage which are employed to facilitate pleural drainage. Thoracic duct embolization by interventional radiology, in the recent years, is of added benefit.…”

“…Fontan completion, Glenn shunt, repair of transposition of great arteries, heart transplantation) it could also complicate non-cardiac thoracic surgeries (oesophageal, lung or mediastinal). 4,6,7 ABSTRACT Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries.…”