Thoracoscopic pleural clipping for the management of congenital chylothorax

Purpose Medical management of congenital chylothoraces consists of total parental nutrition and tube thoracostomy. However, these infants are exposed to significant fluid shifts and the related leukopenia carries a high infection risk. The purpose of this review is to describe the technique of parie...

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Bibliographic Details
Published in:Pediatric surgery international 2015-12, Vol.31 (12), p.1133-1137
Main Authors: Clark, Margaret E., Woo, Russell K., Johnson, Sidney M.
Format: Article
Language:English
Subjects:
Chylothorax - congenital
Chylothorax - surgery
Female
Humans
Infant
Infant, Newborn
Male
Medicine
Medicine & Public Health
Original Article
Pediatric Surgery
Pediatrics
Pleura - surgery
Retrospective Studies
Surgery
Thoracoscopy - methods
Treatment Outcome
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Summary:Purpose Medical management of congenital chylothoraces consists of total parental nutrition and tube thoracostomy. However, these infants are exposed to significant fluid shifts and the related leukopenia carries a high infection risk. The purpose of this review is to describe the technique of parietal pleural clipping as a surgical treatment of congenital chylothorax. Methods The medical records of all patients with a chylothorax diagnosis during the study period of January 2002 to April 2014 were retrospectively reviewed. Results Six of 14 infants identified underwent thoracoscopic parietal pleural clipping to disrupt the pleural lymphatic channel flow as visualization of the thoracic duct and lymphatics was not possible. Nearly all surgical patients had bilateral disease (5/6). Resolution of chylous leakage was dramatic following parietal clipping. In the surgical patients, chest tube output 2 days prior to surgery averaged 86.96 ml/kg/day. After parietal clipping, chest tube output dropped to an average of 6.5 ml/kg/day on post op day 2. Thereafter, chest tube output remained low to negligible and chest tubes were removed variably as enteral feeds were started. Conclusions We describe a straightforward technique of thoracoscopic parietal pleural clipping as a safe and successful option for treatment of congenital chylothoraces.
ISSN:0179-0358
1437-9813
DOI:10.1007/s00383-015-3760-6