Early thoracic duct ligation for postoperative chylothorax

Sieczka, Elizabeth M.; Harvey, James C.

doi:10.1002/(sici)1096-9098(199601)61:1<56::aid-jso12>3.0.co;2-v

Cited by 73 publications

(51 citation statements)

References 18 publications

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“…(13) Additional interventions involving direct ligation of the fistula or ligation of the thoracic duct to the diaphragm are surgical alternatives, (12,14,15) and such procedures can be conducted by thoracotomy or video-assisted thoracoscopy. (16,17) This procedure can reduce mortality rates by as much as 15%.…”

Section: Discussionmentioning

confidence: 99%

“…In the current literature, the principal recommendations are to wait until after up to three weeks of conservative treatment, when there is pleural drainage of 200-500 mL in 24 h. Some studies have suggested that early surgical treatment can spare the patient from significant clinical deterioration, shorten hospital stays and reduce hospital costs. (14) When surgery is opted for, the current tendency is to conduct the procedure using thoracoscopy, with clipping of the thoracic duct, since this technique can lower the rates of morbidity and mortality, as well as increasing the resolution rate. More recently, the use of somatostatin has been discussed as a therapeutic alternative.…”

Section: Discussionmentioning

confidence: 99%

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Fístula linfática após tratamento cirúrgico de síndrome do desfiladeiro torácico à direita

et al. 2009

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One year following pain onset, she began to present paresis of the right hand. The patient was depressed, having been under psychiatric treatment for seven years. Physical examination presented cervical muscle contracture, palmar muscle atrophy with weakened grasp movement and sensory alteration in the same region. The results of Adson's test, military posture and Ross test were positive. The patient was therefore diagnosed with a clinical profile consistent with thoracic outlet syndrome.Electroneuromyography revealed decreased amplitudes in the sensory conduction of the right ulnar nerve, as well as in the motor conduction of the right ulnar and median nerves, conduction block of the right ulnar nerve at elbow level and reinnervation at the C8-T1 level. The motor conduction speed of the right ulnar nerve was 66.7 m/s below elbow level and 47.6 m/s above elbow level.A Doppler ultrasound of the elevated right upper limb revealed significant compression of IntroductionThe supraclavicular approach to surgical treatment of thoracic outlet syndrome is frequently used, since it presents a high rate of therapeutic success and a low risk of complications.(1,2) Brachial plexus lesion and vascular lesions are the most frequent complications. (1,(3)(4)(5) Chylothorax as a complication of this surgical procedure is rare, (6,7) and, if occurring, is normally left-sided.(8) Its incidence ranges from 0.25% to 0.5%, even in general thoracic surgery.(8) Here, we report a case of chylothorax occurring after resection of a right cervical rib and of the right first rib. The chylothorax was successfully treated through an additional surgical procedure. Case reportA 25-year-old female patient, a seamstress having worked in a shoe factory for seven years, was referred to our facility for investigation of a two-year history of progressive pain in the right wrist, accompanied by local paresthesia. AbstractChylothorax as a complication of the surgical treatment of thoracic outlet syndrome is a quite rare event. We report a case of right-sided chylothorax and present a brief review on the treatment of postoperative chylothorax.Keywords: Chylothorax; Thoracic outlet syndrome; Cervical rib syndrome; Postoperative complications. ResumoA fístula linfática como complicação de correção de síndrome do desfiladeiro torácico é um evento muito raro. Relatamos um caso de fístula linfática à direita e apresentamos uma breve revisão do tratamento de quilotórax pós-cirúrgico.Descritores: Quilotórax; Síndrome do desfiladeiro torácico; Síndrome da costela cervical; Complicações pós-operatórias.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fístula linfática após tratamento cirúrgico de síndrome do desfiladeiro torácico à direita

et al. 2009

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“…Additionally, the loss of chyle causes a decrease in the number of T lymphocytes, involving the immunologic system and predisposing patients to infections 5 . Metabolic alterations are due to depletion of electrolytes, and chylomicrons with long-chain fatty acids determine the metabolic alterations.…”

Section: Discussionmentioning

confidence: 99%

“…At one time, shorter periods of conservative treatments, which are often unsuccessful, could minimize cost and damages to the patients, such as weight loss due to a restrictive diet and the pain caused by the permanence of the chylothorax. However, Sieczka and Harvey 5 reported that the conservative treatment may cause an unnecessary delay aggravating the nutritional condition, causing immunological deficiency and exposing the patient to the complications of central venous access necessity.…”

Section: Discussionmentioning

confidence: 99%

Ligation of the thoracic duct for the treatment of chylothorax in heart diseases

Pêgo‐Fernandes

Jatene

Tokunaga

et al. 2003

Arq. Bras. Cardiol.

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If conservative treatment is not effective, surgical treatment should be considered 8 . Studies indicate that ligation of the thoracic duct and pleurodesis are efficient alternatives for resolution of chylothorax 9 .Recently, thoracic duct ligation through video-assisted thoracic surgery has been used in patients who did not respond to conservative treatment. Kirby et al 11 describe this conduct as less painful and with fewer postoperative complications.Pereira et al 12 describe the use of lymphatic ligation for the treatment of postoperative chylopericardium. However, in our country, ligation of the thoracic duct for the treatment of postoperative chylothorax is still a rare procedure, and at what point the conservative treatment should be replaced by postsurgical treatment is still controversial. Thus, our study evaluates the initial results of ligation of the thoracic tract in 4 patients with chylothorax unresponsive to conservative treatment. Case ReportsCase 1 -A four-year-old-male patient with congenital cardiopathy and cyanosis at birth with a previous history of pulmonary atresia without interventricular communication, single left ventricle, hypoplastic right ventricle with sinusoids, left pulmonary artery stenosis, and coronary artery cavitary fistulas. At 5 days of life, he underwent atrial septotomy with the Rashkind procedure, and after 2 days, he underwent a modified left Blalock Taussig shunt procedure. At 4 years old, he underwent a bidirectional Glenn operation with maintenance of the previous Blalock shunt, evolving, in the postoperative period with low cardiac output maintained with vasoactive drugs. He was discharged on the 5th postoperative day, when minor pleural effusion was suspected. A chest X-ray was indicated.After chylothorax was diagnosed, pleural drainage was started. Parenteral nutrition and fasting were introduced after 1 week. The patient evolved with significant persistence of pleural drainage. Nineteen days after the initial In children, chylothorax occurs mainly after cardiac and thoracic surgeries. One of the recommended postsurgery treatments is ligation of the thoracic tract, when all other conservative treatments have failed. We report 4 cases of chylothorax in patients who were successfully treated with this approach, which resulted in a decrease in pleural drainage without recurrent chylothorax.Chylothorax refers to the presence of lymphatic fluid in one or both pleural spaces, secondary to leakage in the thoracic duct or one of its main tributaries 1 . Quinke 2 first described traumatic chylothorax in 1875, after rupture of the thoracic duct.When chylothorax is not treated, the risk of death is high, with rates above 45% 3 , requiring, in the majority of the cases, aggressive treatment.According to DeMeester 4 , chylothorax may be according to its cause, either congenital, traumatic, neoplastic, or multiple causes. Among the traumatic causes surgical procedures with a thoracic approach may cause thoracic duct lesions, leading to the development of chylothorax. Postoperat...

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“…It causes respiratory and metabolic problems and was reported that approximately 25−50% of patients require surgical treatment with mortality of 21% (1). We report of postoperative bilateral chylothorax after transsternal total thymectomy which was treated by one week of fasting with total parenteral nutrition without octreotide injection.…”

Section: Introductionmentioning

confidence: 95%

Bilateral chylothorax after transsternal total thymectomy: resolution with short period of fasting and total parenteral nutrition

et al. 2016

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Bilateral chylothorax after transsternal total thymectomy is very rare, but can be a serious complication. Disruption of minor lymphatic channels in the anterior mediastinum which is remote from thoracic duct is considered to be the cause of chylothorax. We report the case of bilateral chylothorax followed by thymectomy which was treated with pleural drainage, total parenteral nutrition, and fasting without octreotide injection.

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Early thoracic duct ligation for postoperative chylothorax

Cited by 73 publications

References 18 publications

Fístula linfática após tratamento cirúrgico de síndrome do desfiladeiro torácico à direita

Fístula linfática após tratamento cirúrgico de síndrome do desfiladeiro torácico à direita

Ligation of the thoracic duct for the treatment of chylothorax in heart diseases

Bilateral chylothorax after transsternal total thymectomy: resolution with short period of fasting and total parenteral nutrition

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