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Treatment of refractory chylothorax with externalized pleuroperitoneal shunts in children
A B Wolff1, M L Silen, E R Kokoska
1Department of Surgery, St. Louis University Health Sciences Center, Missouri, USA.
Insights
Externalized pleuroperitoneal shunts offer a safe and effective minimally invasive treatment for pediatric refractory chylous effusions, achieving an 84% resolution rate.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Medical Devices
Background:
- Refractory chylothorax in children traditionally treated with pleurodesis or thoracic duct ligation.
- These traditional methods have high morbidity and uncertain success rates.
Purpose of the Study:
- To evaluate the safety and efficacy of pleuroperitoneal shunts with exteriorized pump chambers for treating pediatric chylous effusions.
Main Methods:
- Retrospective review of 15 pediatric patients treated with pleuroperitoneal shunts for chylous effusions.
- Average patient age was 2.1 years; common indication was post-cardiac surgery chylothorax.
- Shunts were in place for an average of 104 days to treat 19 effusions.
Main Results:
- An 84% resolution rate was observed across right-sided, left-sided chylothoraces, and chylopericardia.
- Three patients had persistent effusions despite shunting.
- Complications included shunt malfunction (6 episodes), infection (2 episodes), and hernia development (4 patients).
Conclusions:
- Externalized pleuroperitoneal shunting is a safe, effective, and minimally invasive option for pediatric refractory chylous effusions.
- This approach offers a viable alternative to traditional, more invasive procedures.
Background:
Traditional therapy for refractory chylothorax in the pediatric population has included pleurodesis and thoracic duct ligation. These procedures are associated with high morbidity and questionable success rates.
Methods:
We retrospectively reviewed our experience with 15 patients who underwent treatment for chylous effusions using pleuroperitoneal shunts with exteriorized pump chambers. Mean patient age at time of shunt placement was 2.1 (0.1 to 11.5) years and the most common indication (7 of 15) was refractory chylothorax following surgical correction of congenital heart disease. Mean chylothorax duration before shunt placement was 76 (5 to 810) days and shunts were in place for an average of 104 (12 to 365) days. A total of 19 chylous effusions (pleural or pericardial) were treated with shunts.
Results:
Nine of 11 right-sided chylothoraces, 5 of 6 left-sided chylothoraces, and 2 of 2 chylopericardia resolved with shunt therapy (84% total). Pleuroperitoneal shunting failed to clear the effusion in 3 children. There were six episodes of shunt malfunction that were repaired and two episodes of infection. Inguinal or umbilical hernia developed in 4 patients.
Conclusions:
Externalized pleuroperitoneal shunting is a safe, effective, and minimally invasive treatment for children with refractory chylous effusions.