Non-conservative Management of Chylothorax

Abstract

Chylothorax is caused by lymphatic leakage, which can develop after thoracic surgery and is associated with cancer. Although prospective randomized trials have not been performed, radiological interventions have been performed in several cases with persistent chylothorax, adjunct to 2 weeks of conservative management. The success rate of such interventions is diverse due to anatomical variations, although the results are promising. However, in cases of treatment failure after cycles of interventions, a team approach may be necessary to determine whether surgical management is warranted.

Late-onset tension traumatic chylothorax: A case report and literature review

“…This treatment scheme results in the resolution of over 50% of cases. However, onset factors predict a failure of this management, such as an initial output of > 1000 ml, > 500 ml in 24 h in the 1 st 5 days of the tube's placement, and chylothorax iatrogenic origin 13,14 . Classically, conservative management is described for 2 weeks.…”

“…Classically, conservative management is described for 2 weeks. Nevertheless, there are references of up to 4 weeks of duration in the literature 14 . Our patient received conservative management for 2 weeks, according to the classical management of the pathology.…”

“…When conservative management fails, there are numerous treatment options. The first choice is tying the thoracic duct through Video-Assisted Thoracic Surgery (VATS), which has reported a success rate of approximately 90%, with complications occurring in approximately 38.8% of cases 14,16 . In this modality, the patient is prepared in the pre-operative or transoperative through enteral tube with a high-fat diet (cream or ice cream).…”

“…In this modality, the patient is prepared in the pre-operative or transoperative through enteral tube with a high-fat diet (cream or ice cream). This increases the volume and consistency of the chyle, allowing the surgeon to identify the thoracic duct clearly 14 .…”