MANAGEMENT OF PEDIATRIC POSTOPERATIVE CHYLOTHORAX

Questions persist about the management of postoperative chylothorax in infants and children. Our experience with postoperative chylothorax o ver the most recent decade (1980 to 1990) has been reviewed. The type and amount of drainage, data from cardiac catheterization and echocard iography, operative decisions and details, and eventual outcomes have been cataloged. All patients were initially treated with total gut res t, with operation reserved for unabated drainage. Chylothorax develope d postoperatively in 15 infants and 11 children (18 with a cardiac pro cedure and 8 with a noncardiac procedure). The average age was 3.1 yea rs. Spontaneous cessation and cure occurred in 19 (73.1%) of these 26 patients, with an average drainage duration of 11.9 days (range, 4 to 30 days). Those for whom operation was chosen drained preoperatively f or an average of 29.2 days (range, 25 to 40 days). There were no death s in either group. Complications were lymphopenia (2 patients) and fun gal sepsis (1 patient). The amount of drainage per day was not signifi cantly different between patients treated operatively and those treate d nonoperatively. Failure of nonoperative management was associated wi th venous hypertension from increased right-sided cardiac pressures or central venous thrombosis (p < 0.05, Fisher's exact test). Presumably this increased pressure is transmitted to the lymphatic system. These patients should be identified early and considered for thoracic duct suture or pleuroperitoneal shunting.