Management of postoperative chylothorax

Rieu, M. Chalret du; Mabrut, J.‐Y.

doi:10.1016/j.jviscsurg.2011.09.006

Cited by 58 publications

(48 citation statements)

References 38 publications

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“…Pleurodesis has been recommended for refractory chylothorax that does not respond to medical or surgical intervention or the fenestration of the diaphragm, and some have also advocated for the creation of pleura-peritoneal windows to treat this condition. [14][15][16] However, none of our patients required these procedures. The vast majority responded to the use of conservative management or thoracic duct ligation without the need for further interventions that are often necessary in severe refractory cases.…”

Section: Discussionmentioning

confidence: 78%

Chylothorax following pediatric cardiac surgery

Yıldız¹,

Öztürk²,

Altin³

et al. 2015

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada şilotoraksın insidansı, tedavi protokolleri ve pediatrik kardiyovasküler cerrahi sonrası erken dönem bulgular üzerindeki etkisi değerlendirildi. Ça lış ma pla nı: Haziran 2011 -Haziran 2014 tarihleri arasında kliniğimizde kalp ameliyatı geçiren 1123 pediatrik hastanın kayıtları retrospektif olarak incelendi. Ameliyat sonrası şilotoraks gelişen 35 hasta (19 erkek, 16 kız; ortanca yaş 240 gün; dağılım 5 gün-15 yıl) çalışmaya dahil edildi. Bul gu lar: Şilotoraks gelişimi en sık tek ventrikül tamirlerinde saptandı (n=11, %31). Bunu aortik ark tamiri (n=9, %25), Fallot tetralojisi (n=4, %11) atriyoventriküler septal defekt tamirleri (n= 4, %11), arteriyel switch ameliyatları (n=3, %8), ventriküler septal defekt tamirleri (n=2, %6) ve diğer ameliyatlar (n=2, %6) izledi. Ortanca şilotoraks drenaj süresi dokuz gün (dağılım 2-44 gün) idi. Beslenme yönetimi yağdan fakir diyet, orta zincirli yağ asitlerinden zengin enteral beslenme ve total parenteral beslenmeyi içerdi. On dört hastaya oktreotid, dört hastaya duktus torasikus ligasyonu ve dört hastaya plörodezis uygulandı. Dokuz hastada sepsis gözlendi ve üç hasta kaybedildi. So nuç:Pediatrik kardiyak cerrahi sonrası gelişen şilotoraks nadir olmayan bir komplikasyondur. En sık tek ventrikül tamiri sonrasında gelişir ve ameliyat sonrası klinik seyir ve morbidite üzerinde anlamlı etkiye sahiptir.Anah tarsöz cük ler: Kardiyak cerrahi; çocuklar; şilotoraks. ABSTRACT Background:This study aims to evaluate the incidence, treatment protocols, and impact of chylothorax on early outcomes after pediatric cardiovascular surgery. Methods: Records of 1,123 pediatric patients who underwent heart operation at our clinic between June 2011 and June 2014 were reviewed retrospectively. Thirty-five patients (19 males, 16 females; median age 240 days; range 5 days to 15 years) who developed postoperative chylothorax were included in the study. Results: Development of chylothorax was detected most frequently in single ventricle repairs (n=11, 31%). It was followed by aortic arch repairs (n=9, 25%), tetralogy of Fallot (n=4, 1%), atrioventricular septal defect repairs (n=4, 11%), arterial switch operations (n=3, 8%), ventricular septal defect repairs (n=2, 6%), and other operations (n=2, 6%). Median duration of drainage of chylothorax was nine days (range, 2 to 44 days). Nutritional management included low lipid diet, enteral feedings enriched with mediumchain triglycerides, and total parenteral nutrition. Fourteen patients were administered octreotide, four patients were administered thoracic duct ligation, and four patients were administered pleurodesis. Sepsis was observed in nine patients and three patients died. Conclusion: Chylothorax developing after pediatric cardiac surgery is not a rare complication. It occurs most frequently after single ventricle repair and has a significant impact on postoperative clinical course and morbidity.

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Section: Discussionmentioning

confidence: 78%

Chylothorax following pediatric cardiac surgery

Yıldız¹,

Öztürk²,

Altin³

et al. 2015

Turk Gogus Kalp Dama

View full text Add to dashboard Cite

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“…Radiographic embolization has been proposed as an alternative to surgery. 20 In selected cases, video-assisted thoracic surgery (VATS) should be considered in the treatment of chylothorax. 21 Fahimi and colleagues 7 suggested the use of VATS in the treatment of postoperative chylothorax when daily leakage exceeds 200 mL after 2 weeks of conservative therapy.…”

Section: Discussionmentioning

confidence: 99%

Conservative Management of Chylothorax after Coronary Artery Bypass Grafting

Altun¹,

Pulathan²,

Kutanıs³

et al. 2015

Texas Heart Institute Journal

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Chylothorax is rare as a sequela to cardiac surgery. Its prevalence in cardiothoracic procedures is 0.3% to 1.5%; after median sternotomy, it is still more unusual.1,2 It is more frequent in pediatric than in adult cardiothoracic surgery. 3-5Postoperative chylothorax is associated with high rates of morbidity and mortality. 6 It can cause metabolic disturbances, nutritional deficiencies, respiratory disorders, immunodeficiency and infections, prolonged hospitalization, and high treatment costs. 7,8 Chylothorax after coronary artery bypass grafting (CABG) is rare, but it occurs most often if the left internal mammary artery (LIMA) has been used as a graft. We describe 2 cases of chylothorax that developed in adults after CABG, both of which were treated successfully with medical therapy alone. Case Reports Patient 1A 60-year-old man was admitted to our institution after a sudden onset of chest pain that radiated to his left arm. Coronary angiographic results led our heart team to perform CABG.After a median sternotomy, the LIMA was harvested as a peduncle, the pleura was incised, and the saphenous vein was harvested. First, the reversed saphenous vein graft was anastomosed to the 2nd diagonal branch (D2). Then the LIMA was anastomosed to the left anterior descending coronary artery (LAD). After the proximal anastomosis, the patient was weaned from cardiopulmonary bypass.The operative and first postoperative days were eventless. On the 2nd postoperative day, pale pink discoloration of the pleural drainage fluid was noticed. Chylothorax was diagnosed when biochemical analysis of the pleural fluid revealed total cholesterol, 43 mg/dL; triglycerides, 398 mg/dL; glucose, 67 mg/dL; and total protein, 2.7 g/dL. Pleural drainage was 100 to 250 mL/d.From the outset, the patient was given nothing by mouth but received, via total parenteral nutrition (TPN), a low-fat diet rich in medium-chain fatty acids (MCFA) (total calorie intake, 1,800 kcal/d. In addition, intravenous somatostatin was started (infusion rate of 3.5 µg/kg/hr for the first 48 hr, increased to 5 µg/kg/hr for the next 48 hr, and then to 7 µg/kg/hr for the 3rd 48 hr). No side effects-such as hypersensitivity, hypotension, or hypoglycemia-were noted.On the 7th postoperative day, the patient's oral intake of a low-fat diet was started. The pleural drainage fluid decreased during the course of this conservative therapy. The chest tube was removed on postoperative day 13, after the drainage of fluid had ceased. Follow-up chest radiography yielded normal results. The patient was dis-

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“…Ezek az eljárások önmagukban és az esetek többségében nem sikeresek (sikerráta 23-52%). Ezért sok helyen a diéta csupán része a komplex kezelés-nek (1. táblázat) [5,11,[32][33][34][35][36][37].…”

Section: áBraunclassified

“…Tüdőrákműtét során végzett mediastinalis lymphadectomia nyomán 0,26-3%-ban lép fel ChTX [4]. Ha a folyamat nem uralható vagy krónikussá válik, a malnutritio és az immunológiai komplikációk miatt 50%-os mortalitással is lehet számolni [5]. A ChTX kezelési lehetőségei jelenleg a konzervatív, sebészi és -legújabban -az intervenciós radiológiai, illetve radiációs eljárások.…”

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A chylothorax modern kezelésének bizonyítékalapú áttekintése

2016

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A chylothorax napjainkban rendszerint műtéti vagy baleseti szövődmény, ritkábban daganat következménye. Prospektív vagy randomizált vizsgálatok hiányában a bizonyítékalapú kezelés személyes tapasztalaton, ideálisan a retrospektív elemzések ismeretében történik. A szerzők célja a chylothorax modern kezelésének áttekintése. A PubMed adatbázist "chylothorax" kulcsszóra szűrték az elmúlt tíz év közleményei között, kiemelve az összehasonlító értéke-léseket. A módszerek és ajánlások kritikai elemzésekor a szerzők együttes 39 éves klinikai tapasztalatukra támaszkod-tak. A konzervatív kezelés sikere az etiológiától függően nagy szórást mutat (3-90%). A non-és szemi-invazív intervenciós eljárások sikerrátája 50-100% közötti. Eredménytelen konzervatív kezeléskor a sebészi kezelés, elsősorban a ductus thoracicus lekötése jelenti a standard terápiát. Ezen beavatkozások sikerességi aránya 64-100% közötti, a morbiditási/mortalitási mutató elérheti a 25%-ot. A kezelést konzervatívan kell megkezdeni, majd egy lépcsőzetes agresszivitású terápia ajánlott, amelyben a beteg állapota és a drénvolumen irányítják a döntéshozatalt. Az intervenciós radiológiai eljárások biztonságosak, sikeresek és helyet kaptak a konzervatív és műtéti megoldások mellett. Orv. Hetil., 2016, 157(2), 43-51. Kulcsszavak: chylothorax, szövődmény, mellkassebészet Review of evidence-based modern treatment for chylothoraxChylothorax is a multi-factorial complication, frequently of an operation or an accident, but rarely of a tumour. In the absence of prospective or randomised studies evidence-based treatment is normally based on personal experience, ideally in the possession of retrospective analyses using the "best practice" method. The aim of the authors was the review the up-to-date chylothorax treatments. They performed the PubMed database's "chylothorax" keyword search of the publications reported in the last ten years. They put emphasis on articles that included a comparative analysis of the various treatment options. During the critical analysis of the methods and recommendations, the authors relied on their own joint experience amounting to 39 years. The results showed that the success of the initial conservative treatment indicates a signifi cant deviation depending on the etiology (3-90%). The success rate of noninvasive or semi-invasive interventions is between 50-100%, again depending on the etiology. The standard surgical treatment following an unsuccessful conservative treatment of an operable patient includes the fi tting of a (thoracoscopic) knot to the ductus thoracicus, pleurodesis, insertion of a permanent chest drain or a pleuroperitoneal shunt. The success rate of these interventions is between 64-100%, with a morbidity index and mortality index exceeding 25%. Conservative treatment should be the fi rst step, which should then be followed by a gradually increased aggressive therapy, during which the decisions should be made according to the patient's condition and the drain volume. Interventional radiology procedures are safe, successful an...

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Management of postoperative chylothorax

Cited by 58 publications

References 38 publications

Chylothorax following pediatric cardiac surgery

Chylothorax following pediatric cardiac surgery

Conservative Management of Chylothorax after Coronary Artery Bypass Grafting

A chylothorax modern kezelésének bizonyítékalapú áttekintése

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