MANAGEMENT OF CHYLOTHORAX AFTER PULMONARY RESECTION

BACKGROUND: Conservative management with intrapleural drainage and tot al parenteral nutrition (TPN) has been the first choice of treatment f or postoperative chylothorax. With this approach, however, it usually takes several weeks for the chylothorax to resolve and it is sometimes unsuccessful. In this study, we reviewed seven patients who had chylo thorax develop after pulmonary resection for primary carcinoma of the lung. STUDY DESIGN: The patients were treated according to a ''one-wee k trial'' that consisted of one week of observation with intrapleural drainage and maximum parenteral nutritional support followed by operat ive intervention if the effect of the conservative therapy was not ade quate. When the chylous leak was decreased to less than 100 mL/day or less than 15 percent of the maximum daily drainage volume after the '' one-week trial,'' the conservative management was continued for two mo re weeks. After observation for three weeks, oral intake was begun and a final evaluation of the treatment was made. RESULTS One patient did not consent to the ''one-week trial'' and underwent operative treatme nt on the third postoperative day. Two patients had chylous leaks less than 100 mL/day or less than 15 percent of the maximum daily chylous leak after one week observation. Conservative management with TPN was continued in these patients for two more weeks and operation was perfo rmed in one on the 20th day and in the other on the 22th postoperative day. The remaining four patients underwent operative treatment on the seventh or eighth postoperative day. All of the operations for chylot horax were successful, and chest tubes were removed promptly. These re sults show that operative management of chylothorax was reliable and s afe. The ''one-week trial,'' however, offered few advantages in determ ining the therapeutic strategy for postoperative chylothorax. CONCLUSI ONS: We recommend a quick reoperation for postoperative chylothorax wh en the patient can withstand the procedure. Conservative management la sting for more than one week is indicated only in patients whose posto perative condition is poor.