Treatment of Postsurgical Chylothorax.

Area of Science:

• Thoracic Surgery
• Interventional Pulmonology
• Surgical Critical Care

Background:

• Postoperative chylothorax is a rare but serious complication following thoracic and esophageal surgeries.
• Management options include observation, nutritional support, surgical ligation, pleurodesis, and thoracic duct embolization.

Purpose of the Study:

• To compare the efficacy of standard therapies (surgical duct ligation, observation) with newer treatments (thoracic duct embolization) for postoperative chylothorax.
• To identify predictors of treatment success and guide clinical decision-making.

Main Methods:

• A retrospective review of a prospectively maintained database of 97 patients with postoperative chylothorax (2008-2015).
• Analysis of treatment outcomes based on intervention type: observation, surgical duct ligation, and thoracic duct embolization.
• Evaluation of diagnostic lymphangiography and cisterna chyli cannulation success rates.

Main Results:

• Patients requiring intervention had significantly higher median peak chest tube output (1,910 mL) compared to those managed by observation (725 mL).
• Surgical duct ligation achieved an 85% success rate in 52 patients.
• Diagnostic lymphangiography identified leaks in 85% of patients, but cisterna chyli cannulation was successful in only 48%.

Conclusions:

• Patients with postoperative chylous chest tube output ≥1,100 mL/24 hours should be considered for intervention.
• Surgical duct ligation demonstrates higher efficacy than thoracic duct embolization.
• Lymphangiography can aid in selecting the optimal treatment strategy, with cisterna chyli cannulation being a key factor for embolization success.