DOI: http://dx.doi.org/10.18203/2349-2902.isj20195953

Management and overview of postoperative chylothorax after congenital cardiothoracic surgery

Dhananjay Bansal, Vaibhav Chugh, Rahul Bhushan, Javed M. Banday, Narender S. Jhajhria, Vijay Grover, Vijay K. Gupta

Abstract


Background: The aim of the study was to determine the incidence, risk factors, and outcomes for chylothorax in patients undergoing cardiothoracic surgery, with special emphasis on its management.

Methods: Total of 24 patients with post-operative chylothorax, operated from September 2015 to December 2018, was included in the study. Medical records were maintained, including daily records of drainage volumes and management.

Results: From September 2015 to December 2018, there were 24 cases of chylothorax in 600 congenital cardio-thoracic surgeries-an incidence of 4.0%. Overall mortality rate was similar, but cases had longer postoperative hospital stays (median, 22 versus 8 days). Incidence of chylothorax was significantly higher with congenital cardiac procedures. Diagnosis was made at a median of 6 days after surgery. Duration of drainage was a median of 15 days, with 11 patients draining more than 30 days. Longer duration of drainage was associated with cavopulmonary anastomosis procedure. Nutritional management included low fat diet, enteral feeds enriched with medium-chain triglycerides, and parenteral nutrition. Three patients were treated with octreotide, 4 with thoracic duct ligation, and 1 with pleurodesis. Octreotide was associated with a variable effect on drainage. Thoracic duct ligation reduced, but did not stop drainage.

Conclusions: Chylothorax increases duration of hospitalization after cardiovascular surgery in children. Early diagnosis may reduce the duration of chylothorax. Nutritional strategies remain the cornerstone for management of postoperative chylothorax. The impact of octreotide and surgical intervention is limited when reserved for patients with severe or prolonged drainage.


Keywords


Chylothorax, Nutrition, Octreotide and thoracic duct ligation

Full Text:

PDF

References


Beghetti M, La Scala G, Belli D, Bugmann P, Kalangos A, Le Coultre C. Etiology and management of pediatric chylothorax. J Pediatr. 2000;136:653-8.

Bond SJ, Guzzetta PC, Snyder ML, Randolph JG. Management of pediatric postoperative chylothorax. Ann Thorac Surg. 1993;56:469-73.

van Straaten HL, Gerards LJ, Krediet TG. Chylothorax in the neonatal period. Eur J Pediatr. 1993;152:2-5.

Buttiker V, Fanconi S, Burger R. Chylothorax in children. Guidelines for diagnosis and management. Chest. 1999;116:682-7.

Allen EM, Vanheeckeren DW, Spector ML, Blumer JL. Management of nutritional and infectious complications of postoperative chylothorax in children. J Pediatr Surg. 1991;26:1169-74.

Robinson CL. The management of chylothorax. Ann Thorac Surg. 1985;39:90-5.

Puntis JWL, Roberts KD, Handy D. How should chylothorax be managed? Arch Dis Childhood. 1987;62:593-6.

Cormack BE, Wilson NJ, Finucane K, West TM. Use of Monogen for pediatric postoperative chylothorax. Ann Thorac Surg. 2004;77:301-5.

Fahimi H, Casselman FP, Mariani MA, van Boven WJ, Knaepen PJ, van Swieten HA. Current management of postoperative chylothorax. Ann Thorac Surg. 2001;71:448-50.

Browse NL, Allen DR, Wilson NM. Management of chylothorax. Br J Surg. 1997;84:1711-6.

Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative chylothorax. J Thorac Cardiovasc Surg. 1996;112:1361-5.

Rosti L, Bini RM, Chessa M, Butera G, Drago M, Carminati M. The effectiveness of octreotide in the treatment of post-operative chylothorax. Eur J Pediatr. 2002;161:149-50.

Pratap U, Slavik Z, Ofoe VD, Onuzo O, Franklin RC. Octreotide to treat postoperative chylothorax after cardiac operations in children. Ann Thorac Surg. 2001;72:1740-2.

Al Zubairy SA, Al Jazairi AS. Octreotide as a therapeutic option for management of chylothorax. Ann Pharmacother. 2003;37:679-82.