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Efficacy of Early Pleurectomy for Severe Congenital Chylothorax
Nathan S Rubalcava1, Erin E Perrone1, Joseph T Church1
1Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
Insights
Early surgical intervention with pleurectomy for severe congenital chylothorax (SCC) may improve neonatal survival and reduce hospital stays. This approach, combined with mechanical pleurodesis and thoracic duct ligation, offers an effective treatment for persistent SCC.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Thoracic Surgery
Background:
- Severe congenital chylothorax (SCC) poses significant risks including respiratory failure, malnutrition, immunodeficiency, and sepsis.
- While initial management involves conservative measures like bowel rest, parenteral nutrition, and octreotide, persistent cases necessitate surgical intervention.
- Our institution utilizes pleurectomy, mechanical pleurodesis, and thoracic duct ligation for SCC management.
Purpose of the Study:
- To evaluate the effectiveness of pleurectomy combined with mechanical pleurodesis and thoracic duct ligation in managing severe congenital chylothorax.
- To compare outcomes, including survival and length of stay, between early and late surgical intervention.
Main Methods:
- A retrospective review of neonatal patients with SCC managed surgically between 2000 and 2015.
- Patients were categorized into an early surgery group (pleurectomy within 28 days of diagnosis) and a late surgery group (pleurectomy after 28 days).
- Outcomes assessed included overall survival, resolution of chylothorax, and length of hospital stay.
Main Results:
- Fifteen patients underwent pleurectomy; 8 in the early group and 7 in the late group.
- Overall survival was 67% (10 of 15 patients).
- The early surgery group demonstrated higher survival rates (88% vs. 43%), shorter hospital stays (P=0.05), and resolution of chylothorax.
Conclusions:
- Pleurectomy with mechanical pleurodesis and thoracic duct ligation is an effective surgical strategy for severe congenital chylothorax.
- Earlier surgical intervention via pleurectomy may be associated with improved survival and reduced hospital length of stay in neonates with SCC.
Background:
Severe congenital chylothorax (SCC) may result in respiratory failure, malnutrition, immunodeficiency, and sepsis. Although typically managed with bowel rest, parenteral nutrition, and octreotide, persistent chylothoraces require surgical management. At our institution, a pleurectomy, unilateral or bilateral, in combination with mechanical pleurodesis and thoracic duct ligation is performed for SCC, and we describe our approach and outcomes.
Materials And Methods:
We reviewed over 15-year period neonatal patients with SCC managed surgically with pleurectomy after medical therapy was unsuccessful. Patients were divided into two groups: those who underwent pleurectomy within 28 d of diagnosis (early group) and those who underwent pleurectomy after 28 d (late group). Resolution of chylothorax was defined by the absence of clinical symptoms as well as absent or minimal pleural effusion on chest X-ray.
Results:
Of 40 patients diagnosed with SCC over the study period, 15 underwent pleurectomy, eight early [mean time to operation = 20 (IQR 17, 23) d] and 7 late [59 (42, 75) d, P = 0.001]. Overall survival was 67% (10 of 15). Seven of 8 (88%) neonates who underwent early pleurectomy survived versus 3 of 7 (43%) who underwent late pleurectomy (P = 0.07). Length of stay was lower in the early group than the late group [73 (57, 79) versus 102 (109, 213) d, P = 0.05]. All patients who survived to discharge had resolution of their chylothorax.
Conclusions:
Pleurectomy with mechanical pleurodesis and thoracic duct ligation is effective in the management of severe congenital chylothorax. When performed earlier, pleurectomy for severe congenital chylothorax may be associated with improved survival and shorter hospital length of stay.
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