Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery

Area of Science:

• Pediatric Surgery
• Thoracic Surgery
• Critical Care Medicine

Background:

• Limited data exists on the outcomes of thoracic duct ligation (TDL) for pediatric patients with postsurgical chylothorax refractory to medical management.
• Postsurgical chylothorax is a known complication, but treatment strategies for persistent cases require further investigation.

Purpose of the Study:

• To evaluate the effectiveness and outcomes of thoracic duct ligation (TDL) in pediatric patients with refractory postsurgical chylothorax.
• To identify risk factors associated with treatment failure or mortality after TDL.

Main Methods:

• A retrospective review was conducted on pediatric patients who underwent TDL following cardiothoracic surgery between 1992 and 2007.
• Data collected included patient demographics, cardiac morphology, chylous drainage characteristics, medical management, and post-TDL outcomes, including imaging of upper body venous drainage.

Main Results:

• Twenty pediatric patients (median age, 0.65 years) with chylothorax underwent TDL after a median of 17.5 days of medical management.
• TDL resulted in a significant reduction in chest tube drainage (median 13 mL x kg(-1) x d(-1) post-TDL vs. 34.5 mL x kg(-1) x d(-1) pre-TDL; p = 0.003).
• Four deaths occurred (none TDL-related), with 2 treatment failures and 2 recurrences. Upper body venous thrombosis was identified in 3 patients and was a risk factor for adverse outcomes.

Conclusions:

• Thoracic duct ligation is an effective intervention for reducing chest tube drainage and facilitating prompt removal in pediatric patients with refractory postsurgical chylothorax.
• Early consideration of TDL should be given in these challenging cases.
• Upper body venous thrombosis is associated with a high risk of TDL failure and mortality, warranting careful patient selection and monitoring.