Current management of postoperative chylothorax

Background. This study was performed to review our experience with postoper ative chylothorax and describe our current approach. In addition, we wanted to estimate the impact of video-assisted thoracoscopic surgery (VATS) on o ur current management policy. Methods. From January 1991 to December 1999, 12 patients developed chylotho rax after various thoracic procedures. Their mean age was 61.5 (range 31 to 80 years). The procedures were cardiac, aortic, and pulmonary operations. Results. All patients were initially treated conservatively. In addition, 7 patients needed surgical intervention, including one thoracotomy and six V ATS. The site of thoracic duct laceration was identified and treated with V ATS in 4 patients. In 2 patients, the leak could not be localized by VATS, and fibrin glue or talcage were applied in the pleural space. All patients were discharged without recurrent chylothorax. Conclusions. VATS is an effective tool in the management of persisting post operative chylothorax. Its easy use, low cost, and low morbidity rate sugge st an earlier use of VATS in the treatment of postoperative chylothorax. (C ) 2001 by The Society of Thoracic Surgeons.