CHYLOTHORAX - A RARE COMPLICATION OF TRAN SAXILLARY THORACIC SYMPATHECTOMY

Transaxillary upper thoracic sympathectomy is a safe surgical procedur e for the treatment of palmar hyperhidrosis. Although thoracic complic ations such as hemothorax and pneumothorax occasionally occur followin g this procedure chylothorax is an extremely rare complication. From 1 978 to 1991, 215 consecutive patients underwent upper thoracic sympath ectomy for the treatment of palmar hyperhidrosis in our institution. W e report the surgical management of one patient who developed an intra ctable chylous fistula which did not respond to non-surgical treatment . Attemps at non-surgical management of the disease, with aspiration t herapy, tube thoracostomy and the administration of medium chain trigl yceride diet, should be tried first. If, however, this is not successf ul within two weeks, one should not wait for further metabolic and nut ritional impairment before instituting surgical treatment. We believe that proximal thoracic duct ligation is a relatively simple and effect ive means of controlling chylothorax.