Original scientific paper

The contemporary approach to chylothorax – Single-center experience with the proposal of a management algorithm

Ivan Bačić ; University of Zadar, Department of Health Studies, Zadar, Croatia; Zadar General Hospital, Department of Surgery, Zadar, Croatia
Domagoj Morović ; General Hospital, Department of Surgery, Zadar, Croatia
Ivan Kovačić ; General Hospital, Department of Surgery, Zadar, Croatia
Dario Vukosav ; General Hospital, Department of Surgery, Zadar, Croatia
Željko Čulina ; General Hospital, Department of Pulmonology, Zadar, Croatia
Jakov Mihanović ; University of Zadar, Department of Health Studies, Zadar, Croatia; Zadar General Hospital, Department of Surgery, Zadar, Croatia

Abstract

Objectives: Chylothorax is a relatively rare condition of lymphatic fluid accumulation in the thoracic
cavity due to a leakage from the thoracic duct or its tributaries. Patients present with dyspnea, malnutrition,
and immunosuppression. Treatment can be conservative or surgical, depending on etiology and clinical
course. The optimal management algorithm for chylothorax is still controversial.
Methods: This is a ten-year period retrospective study of all patients with chylothorax treated at our
Department of Thoracic Surgery.
Results: A total of 14 patients were identified for the study. Nine patients had chylothorax after lung or
esophageal cancer surgery. Four patients had chylothorax in advanced lymphoma. One patient had
chylothorax after blunt chest trauma. A conservative approach was initiated in most patients (92%),
including pleural drainage, nil per mouth, total parenteral nutrition, and somatostatin 0.1 mg bid
subcutaneously. Surgical treatment was indicated in patients with thoracic drain production >800 mL per
day beyond the fifth day of treatment and those with blunt thoracic trauma. Two patients had thoracic duct
ligation via right-sided thoracotomy, and five patients had video-assisted thoracoscopic thoracic duct
ligation with the immediate arrest of chylous leakage.
Conclusion: Chylothorax should be treated conservatively initially. Surgical treatment should not be
delayed beyond the fifth day in case of failure. In our series of patients, a video-assisted thoracoscopic
approach for thoracic duct ligation proved to be minimally invasive, highly efficient, and well tolerated.
Therefore, it should be the preferable route of surgical treatment.

Keywords

Chylothorax; Thoracic Duct; Video-Assisted Thoracoscopic Surgery

Hrčak ID:

320581

URI

https://hrcak.srce.hr/320581

Publication date:

6.9.2024.

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