postoperative chylothorax

postoperative chylothorax

A rare (0.5–2.0%) complication of thoracic surgery, which is characterised by milky fluid drainage, and which should be suspected in the presence of new pleural effusion and dyspnoea after thoracic surgery.

Diagnosis
Biochemistry—increased triglycerides and cytology; lymphocytosis in pleural fluid.

Morbidity
Malnutrition, dehydration, immune dysfunction; large-volume chylothorax may compromise cardiopulmonary, renal, and hepatic function.

Mortality
Up to 50%, especially if unsuspected and/or in the chronically ill.
References in periodicals archive ?
Radiotherapy in the treatment of postoperative chylothorax. J Cardiothorac Surg 2013; 8: 72.
Management of postoperative chylothorax. J Visc Surg 2011; 148: e346-52.
Bhatnagar, "Management of postoperative chylothorax in a patient with carcinoma of thyroid and lymphadenopathy," Middle East Journal of Anesthesiology, vol.
Beghetti, "Treatment of a persistent postoperative chylothorax with somatostatin," Annals of Thoracic Surgery, vol.
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.
Postoperative chylothorax: Differences between patients who received median sternotomy or lateral thoracotomy for congenital heart disease.
(2,3) The optimal management of postoperative chylothorax is controversial.
Postoperative chylothorax was confirmed by the presence of chylomicrons in the pleural effusion and triglyceride levels above 6.1 mmol/l.
Octreotide for treatment of postoperative chylothorax. Journal of Pediatrics, 139, 157-159.
Octreatide to treat postoperative chylothorax after cardiac operations in children.
Video-assisted thoracoscopy (VAT) has recently been utilized for thoracic duct ligation,[7] fibrin occlusion,[8] clipping,[9] oversewing,[10] or talc pleurodesis.[11] Others, however, recommend conservative treatment with dietary fat restriction, total parenteral nutrition, and periodic thoracentesis or chest tube drainage for 2 to 6 weeks before resorting to operative intervention.[12-13] In an exhaustive review of 132 cases of postoperative chylothorax in the world literature spanning 50 years, Sieczka and Harvey[14] found that the majority were related to malignant thoracic disease, with only 7 (5%) associated with benign cardiovascular procedures.
Treatment of postoperative chylothorax by fibrin glue application under thoracoscopic view with use of local anesthesia.

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