POSTOPERATIVE CHYLOTHORAX

Between July 1987 and May 1995, 11,315 patients underwent general thor acic surgical procedures at our institution, In 47 of these patients ( 0.42%), postoperative chylothorax developed, There were 32 men and 15 women with a median age of 65 years (range 21 to 88 years), Initial op eration was for esophageal disease in 27 patients, pulmonary disease i n 13, mediastinal mass in six, and thoracic aortic aneurysm in one, Al l patients were initially treated with hyperalimentation, cessation of oral intake, medium chain triglyceride diet, or a combination, Nonope pative therapy was successful in 13 cases (27.7%), and oral intake was resumed a median of 7 days later (range 2 to 15 days), Reoperation wa s required in the remaining 34 cases, The reoperation rate varied acco rding to the type of initial operation. Twenty-four of the 27 patients (88.9%) who had undergone an esophageal operation required reoperatio n, versus only five of 13 patients (38.5%) who had undergone pulmonary resection (p < 0.001), Lymphangiography was performed in 16 patients and identified the site of the leak in 13, The thoracic duct was ligat ed in 32 of the 34 patients who required reoperation (94%), The remain ing two patients were treated with mechanical pleurodesis and fibrin g lue. Reoperation was successful in 31 of the 34 patients (91.2%), The single death among the 47 patients (2.1%) occurred in the reoperated g roup, Complications occurred in 18 patients (38.3%), Factors that pred icted the need for reoperation were initial esophageal operation and a verage daily postoperative drainage greater than 1000 ml/day for 7 day s, We conclude that postoperative chylothorax is an infrequent complic ation, Some cases can be managed without operation; however, we recomm end early reoperation when drainage is greater than 1000 ml/day or if the chylous fistula occurs after an esophageal operation, The fistula can usually be controlled by ligation of the thoracic duct.