Successful treatment of postoperative chylothorax using an external pleuroperitoneal shunt

Cummings, Steven P.; Wyatt, David A.; Baker, Joseph W.; Flanagan, Terry L.; Spotnitz, William D.; Rodgers, Bryan; Krön, Irving L.; Tribble, Curtis G.

doi:10.1016/0003-4975(92)91383-k

Cited by 22 publications

(9 citation statements)

References 4 publications

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“…Alternate treatment methods, such as pleuro-peritoneal shunting or interruption of the thoracic duct with interventional radiological techniques, also have been suggested. Milsom et al [Milsom 1985] and Cummings et al [Cummings 1992] reported the effectiveness of pleuro-peritoneal shunting methods. Chen et al [Chen 2011] showed that interventional treatments for chylothorax resulted in good outcomes.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Postoperative Chylothorax Following Congenital Heart Surgery in Pediatric Patients: A Single-Center Experience

Lee

Choi

2020

HSF

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Background: Although postoperative chylothorax following congenital heart surgery occurs rarely, it is associated with substantial morbidity and mortality. The incidence of postoperative chylothorax has been reported as 2% to 5%. Therefore, we aimed to evaluate the incidence of postoperative chylothorax at our center and compared our results with those of other studies. Methods: Between January 2009 and December 2018, there were 2,515 congenital heart repair surgeries performed at our center. Thirty-six patients with postoperative chylothorax were enrolled in this study, and their medical records retrospectively were reviewed. We calculated the overall and surgery-specific incidences. We compared the data of the medical management group with those of the surgical management group. Results: The overall incidence of postoperative chylothorax was 1.4%. The incidence was highest for patients who underwent vascular ring repair (3/32). Moreover, the incidence was higher for single ventricle-related procedure than bi-ventricle-related procedures (5.6% versus 1.0%, P < .0001). Chylothorax was predominantly found on the left side (20/36). Among these cases, six patients died; three of these six were in the surgical management group. Conclusions: The postoperative chylothorax incidence at our center was comparable to those of other centers. However, a reasonable protocol for postoperative chylothorax management to improve outcomes is necessary.

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Section: Discussionmentioning

confidence: 99%

Incidence of Postoperative Chylothorax Following Congenital Heart Surgery in Pediatric Patients: A Single-Center Experience

Lee

Choi

2020

HSF

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“…This frequently leads to inflammation and tenderness of the pump pocket and subsequent non-compliance. 6 Additionally, the small size of both the pump chamber and catheter can lead to early occlusion by proteinaceous debris, necessitating replacement. An external pleuroperitoneal shunt seems to circumvent some of these problems.…”

Section: Discussionmentioning

confidence: 99%

A Simple Solution for Complicated Pleural Effusions

Murthy

Okereke

Mason

et al. 2006

Journal of Thoracic Oncology

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Introduction: Complicated pleural effusions are difficult to manage with conventional strategies. In this study, we review the safety, efficacy, and durability of PleurX catheters (Denver Biomedical, Golden, CO) for managing complicated pleural effusions and describe a patient population who might benefit. Patients and Methods: From July 1999 to February 2003, 63 PleurX catheters were placed in 58 symptomatic patients (an additional five had bilateral catheters) to manage complicated pleural effusions. Patients selected for catheter placement tended to have poor performance status (Eastern Cooperative Oncology Group Յ2) or had failed standard therapies. Of the 63 catheters, 52 (83%) were placed because of malignant complicated pleural effusions. A registry of patients was constructed, and data were obtained from review of medical records. Nonparametric estimates of freedom from reintervention and overall survival were obtained by the Kaplan-Meier method. Results: Catheter-related complications were noted in four of 58 patients (7%) and included one each of pneumothorax, seroma, empyema, and pain syndrome. Freedom from reintervention for effusion management was 95%. Of the patients, 86% (50 of 58) experienced dyspnea relief. There were no procedure-related mortalities. Catheters remained functional up to 330 days, and four of 63 (6%) required one-time thrombolysis with tissue plasminogen activator. Conclusions: PleurX catheters are safe, effective, and durable solutions for complicated pleural effusions and seem to provide an attractive alternative for patients who have few other palliative options. We consider the catheters as first-line therapy for these patients.

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“…8,9 This is important in reoperative cases such as postlobectomy and postesophagectomy chylothorax, where the planes are obliterated and the anatomy is not well defined. 1,6 To accomplish this, the patient is given a diet rich in fat content preoperatively. Several methods have been described that vary from a high fat diet the evening before that includes heavy cream or ice cream.…”

Section: Preoperative Preparationmentioning

confidence: 99%

“…5 The placement of a Denver pleuroperitoneal shunt has been used in patients who are nonoperative candidates; however, these shunts are fraught with complications such as tenderness from the catheter site, obstruction, and patient noncompliance. 6 Thoracic duct embolization via percutaneous catheterization and lymphography is another option. This technique is successful in approximately 70% of cases in which the thoracic duct can be cannulated.…”

mentioning

confidence: 99%