The management of chylothorax.

Area of Science:

• Thoracic Surgery
• Gastroenterology
• Vascular Anatomy

Background:

• Chylothorax, characterized by lymphatic fluid in the pleural space, presents a significant clinical challenge.
• Understanding the thoracic duct's anatomy and physiology is crucial for effective management.
• Conservative therapies for chylothorax have limitations, often necessitating surgical intervention.

Purpose of the Study:

• To describe the anatomy, physiology, and diseases of the thoracic duct.
• To present a management plan for chylothorax.
• To evaluate the efficacy of surgical treatment for refractory chylothorax.

Main Methods:

• A retrospective review of 15 patients treated for chylothorax over 20 years.
• Description of thoracic duct anatomy and physiology.
• Surgical exploration via thoracotomy with intraoperative identification of the thoracic duct using a milk-and-cream mixture.

Main Results:

• Conservative therapy was unsuccessful in patients requiring surgery.
• Surgical treatment via thoracotomy was necessary and efficacious.
• The thoracic duct was readily identified during surgery by the presence of milky fluid after oral administration of a milk-and-cream mixture.
• Oversewing the leaking duct was the primary surgical technique.

Conclusions:

• Surgical intervention is a necessary and effective treatment for chylothorax unresponsive to conservative measures.
• Thoracotomy provides direct access for thoracic duct exploration and repair.
• Preoperative feeding with a milk-and-cream mixture facilitates intraoperative identification of the thoracic duct.