Chylothorax after Pleuro-Pulmonary Surgery: A Rare but Unavoidable Complication

Abstract

The incidence of chylothorax after pleuro-pulmonary operations as well as its treatment is reported. Of 1744 operations performed postoperative chylothorax developed in 13 (0.74%). It resulted in two cases from the transection of the thoracic duct, in six from the transection of the so-called minor lymph channels, which drain lymph from mediastinal nodes straight into the thoracic duct or drain lung segments into the thoracic duct via the pulmonary ligament; the transection of these channels occurred during mediastinal lymphadenectomy or during the section of the pulmonary ligament. In 5 patients the site of leakage was not determined as reoperation was not required. Conservative treatment with low-fat diet and medium-chain triglycerides and/or total parenteral nutrition was attempted in all but one patient but was successful only in 5 cases whose mean losses were 292 ml/day. Seven patients were reoperated after a mean of 11 days; their mean losses were 930 ml/day. One patient was reoperated on the third postoperative day without attempting conservative treatment; his mean loss was 850 ml/day. Lymphadenectomy seems to be an important risk factor for postoperative chylothorax. Chyle leakage around 500 ml/day or higher that tends to decrease below 500 ml/day after a few days of dietary manipulation usually stops within 10-20 days, while leakage over 500 ml/day that does not tend to decrease below 500 ml/day seldom if ever stops without surgery, so that a more aggressive attitude is justified.

Chylothorax and pseudochylothorax

“…It can occur even after thoracoscopic surgery. The incidence of chylothorax after chest surgery of various kinds is around 0.5% [28][29][30].…”

“…The next step is total parenteral nutrition, which will diminish flow even further. In around 50% of patients with traumatic chylothorax, spontaneous healing will occur with conservative treatment [30,35]. Thus, a trial of such treatment is recommended by many surgeons [28,36,37].…”

Chyle Leakage and Early Enteral Feeding following Pancreatico-Duodenectomy: Management Options

“…Disruption of these lymphatic pathways can result in both chylothorax as well as chylous ascites. A variety of mechanisms can result in a chyle leak ranging from congenital defects of the lymphatic system to malignancy or trauma [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]. However, chyle leaks are also a recognised complication of abdominal, thoracic and head and neck surgery [1,2,4,5,6,7,8,9,12,13, 15, 18].…”

“…In the published literature there have been numerous case reports as well as collective reviews of chylothorax [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]. However, there are relatively little data on chylous ascites.…”

Division of the Pulmonary Ligament After Upper Lobectomy is Less Effective for the Obliteration of Dead Space than Leaving It Intact

“…1 We examined the effectiveness of dividing the pulmonary ligament after upper lobectomy by assessing chest X-ray films.…”