Postoperative Chylothorax: Differences Between Patients Who Received Median Sternotomy or Lateral Thoracotomy for Congenital Heart Disease

Wu, Jing; Yao, Chih Ta; Kan, Chung Dann; Yeh, Cheng Nan; Yu, Yang; Wang, Jieh Neng

doi:10.1111/j.1540-8191.2006.00225.x

Cited by 12 publications

(6 citation statements)

References 18 publications

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“…The incidence of postoperative chylothorax is 3.0 % in our study, which is similar to other studies [4,10,12,14]. Chylothorax was discharged in various sites, such as pleural cavity or pericardial space.…”

Section: Discussionsupporting

confidence: 91%

“…Third, controversy exists about the effect of high central venous pressure on conservative therapy for postoperative chylothorax. Wu et al [14] showed that increased central venous pressure might contribute to the prolongation of chylothorax and might be associated with the failure of conservative management. In contrast, Biewer et al [5] showed that increased central venous pressure is not the major driver for postoperative chylothorax.…”

Section: Discussionmentioning

confidence: 98%

“…Chylothorax occurring after surgery for congenital heart disease has a low prevalence of 1.3-9.5 % [4,10,12,14], but it can lead to serious complications, such as infection, malnutrition, and immunosuppression, in newborn and infant patients. Once chylothorax occurs, postoperative management is complicated by incremental hydrolability, which requires careful postoperative management [2,3].…”

Section: Introductionmentioning

confidence: 99%

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Management of Refractory Chylothorax After Pediatric Cardiovascular Surgery

et al. 2012

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We investigated the optimal treatment for refractory chylothorax after pediatric cardiovascular surgery. We retrospectively reviewed the cases of 15 consecutive patients who developed chylothorax after congenital heart surgery performed between December 2004 and November 2010. Among the 15 patients (12 male and 3 female; median age 13.9 months) who developed postoperative chylothorax, 10 recovered with conservative therapy, such as a low-fat diet, medium chain triglyceride-enriched diet, or total parenteral nutrition. Of the remaining 5 patients who underwent surgical treatment followed by conventional therapy, 4 showed improvement, and 1 died from cardiac failure. Surgical treatment was performed at a median of 19 days after diagnosis of chylothorax. Average drainage output of thoracocentesis for the first 5 days before thoracic duct ligation was 33.1 ml/kg/day. Duration of chylous fluid drainage was significantly longer in surgical patients than in patients who recovered with conservative therapy (p < 0.01). Surgical patients tended to be younger with lower body weight. Significant risk factors for surgical intervention were age <4 months, body weight <4 kg, and duration of drainage >10 days. In cases of refractory postoperative chylothorax, surgical therapy such as thoracic duct ligation should be considered when discharge from the drainage tube is >30 ml/kg/day or chylothorax is not improved within 10 days.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Management of Refractory Chylothorax After Pediatric Cardiovascular Surgery

et al. 2012

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“…Nonoperative management can be successful in the majority of cases. 23 Somatostatin may play an adjunctive role in some patients, while doxycycline chemical pleurodesis seems entirely ineffective. Surgical intervention can be reserved for the minority of patients who fail to respond to medical treatment and it is successful.…”

Section: Accurate Diagnosis and Early Treatment Are Important For Achmentioning

confidence: 99%

Etiology and Management of Chylothorax Following Pediatric Heart Surgery

Milonakis

Chatzis

Giannopoulos

et al. 2009

Journal of Cardiac Surgery

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Background: Chylothorax after congenital heart surgery (CHD) is a potentially challenging complication. The purpose of this study was to review our experience with the management of chylothorax following congenital heart surgery. Methods: Between September 1997 and August 2006, of 1341 pediatric patients undergoing correction of congenital heart disease in our institution, 18 (1.3%) developed chylothorax postoperatively. Surgical procedures included tetralogy of Fallot repair in 10 patients, ventricular septal defect closure (one), atrial septal defect with pulmonary stenosis repair (one), Fontan procedure (three), coarctation of the aorta repair (one), aortopulmonary shunt (one), and ligation of patent ductus arteriosus in one patient. All patients followed a therapeutic protocol including complete drainage of chyle collection and controlled nutrition. Somatostatin was used adjunctively in six (33.3%) patients. Surgical intervention was reserved for persistent lymph leak despite maximal therapy. Following resolution of chylothorax, a medium-chain triglyceride diet was implemented for six weeks. Results: There were no deaths. Fifteen patients (83.3%) responded to conservative therapy. Lymph leak ranged from 2.5 to 14.7 mL/kg per day for 8 to 42 days. Three patients with persistent drainage required thoracotomy with pleurodesis to achieve resolution, in two of which previously attempted chemical pleurodesis with doxycycline proved ineffective. Duration of lymph leak in this subgroup ranged from 15 to 47 days with 5.1 to 7.4 mL/kg per day output. Conclusions: Postoperative chylothorax is an infrequent complication of surgery for congenital heart disease and can occur even after median sternotomy in the absence of pathologically elevated venous pressure or Fontan circulation. Although hospitalization can be prolonged, conservative therapy is effective in most cases, while surgical pleurodesis proved successful in the refractory cases. doi: 10.1111/j.1540-8191.2008.00781.x (J Card Surg 2009;24:369-373) Postoperative chylothorax in childhood is a potentially serious complication of any thoracic surgical procedure and its management represents a serious challenge. In particular, chylothorax occurring after pediatric congenital heart surgery is an uncommon complication, occurring in 0.6% to 2% in reported series. 1,2 The intent of our study was to explore the etiology and present our experience with the management of this type of chylothorax. MATERIALS AND METHODS The hospital records of all children with a postop-

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“…In a study comparing the incidence of postoperative chylothorax in children treated by MS or lateral thoracotomy for the correction of congenital cardiac abnormalities, both groups had an equal incidence. [19] The thoracotomy group had a longer latency period before the onset of chylothorax, but in both groups the chylothorax could be managed by medical treatment alone. Finally, it has been well documented that anterolateral thoracotomies in infants can lead to breast and pectoral muscle maldevelopment.…”

Section: Resultsmentioning

confidence: 99%

The versatility of median sternotomy in general paediatric surgery

et al. 2013

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Background. While common in cardiac surgery, median sternotomy (MS) is rarely required in general paediatric surgery. In the era of advancing endoscopic techniques, sternotomy is perceived as an extremely invasive incision, associated with prolonged postoperative recovery and significant morbidity. Methods. We conducted a retrospective chart review of all children undergoing MS for non-cardiac indications between January 2007 and September 2012 and describe the pathology, number of ventilated days, duration of intensive care unit stay and analgesic requirements. Results. Our experience over the past 6 years includes 14 children, aged between 8 months and 13 years. Indications for surgery included penetrating mediastinal trauma (1), anterior and posterior mediastinal masses (4), acquired tracheo-oesophageal fistulas secondary to button battery impaction (2), bronchial foreign bodies (2) and bilateral pulmonary metastases secondary to malignancy (5). The range of postoperative ventilation required was 0 -34 days (median 1 day) and the range of duration of stay in the paediatric intensive care unit 1 -39 days (median 4 days). Postoperative analgesia was provided with intravenous or oral paracetamol with or without the addition of morphine. All the children tolerated the procedure well with no sternotomy-related complications on follow-up. Conclusion. This review highlights the variety of conditions in which MS provides unrivalled access to the mediastinum and how well the procedure is tolerated by the paediatric patient, and emphasises the importance of sternotomy being within the armamentarium of access techniques of the general paediatric surgeon.

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Postoperative Chylothorax: Differences Between Patients Who Received Median Sternotomy or Lateral Thoracotomy for Congenital Heart Disease

Cited by 12 publications

References 18 publications

Management of Refractory Chylothorax After Pediatric Cardiovascular Surgery

Management of Refractory Chylothorax After Pediatric Cardiovascular Surgery

Etiology and Management of Chylothorax Following Pediatric Heart Surgery

The versatility of median sternotomy in general paediatric surgery

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