Pediatric Surgery International

, Volume 31, Issue 12, pp 1133–1137 | Cite as

Thoracoscopic pleural clipping for the management of congenital chylothorax

  • Margaret E. Clark
  • Russell K. Woo
  • Sidney M. Johnson
Original Article
First Online:
Accepted:

Abstract

Purpose

Medical management of congenital chylothoraces consists of total parental nutrition and tube thoracostomy. However, these infants are exposed to significant fluid shifts and the related leukopenia carries a high infection risk. The purpose of this review is to describe the technique of parietal pleural clipping as a surgical treatment of congenital chylothorax.

Methods

The medical records of all patients with a chylothorax diagnosis during the study period of January 2002 to April 2014 were retrospectively reviewed.

Results

Six of 14 infants identified underwent thoracoscopic parietal pleural clipping to disrupt the pleural lymphatic channel flow as visualization of the thoracic duct and lymphatics was not possible. Nearly all surgical patients had bilateral disease (5/6). Resolution of chylous leakage was dramatic following parietal clipping. In the surgical patients, chest tube output 2 days prior to surgery averaged 86.96 ml/kg/day. After parietal clipping, chest tube output dropped to an average of 6.5 ml/kg/day on post op day 2. Thereafter, chest tube output remained low to negligible and chest tubes were removed variably as enteral feeds were started.

Conclusions

We describe a straightforward technique of thoracoscopic parietal pleural clipping as a safe and successful option for treatment of congenital chylothoraces.

Keywords

Chylothorax Chyle leak Thoracic duct Neonate Parietal clipping Pleurodesis 
This is a preview of subscription content, log in to check access.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Mery CM, Moffett BS, Khan MS et al (2014) Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database. J Thorac Cardiovasc Surg 147:678–686.e1 (discussion 685-6) Google Scholar
  2. 2.
    Epaud R, Dubern B, Larroquet M et al (2008) Therapeutic strategies for idiopathic chylothorax. J Pediatr Surg 43:461–465CrossRefPubMedGoogle Scholar
  3. 3.
    Shah D, Sinn JK (2012) Octreotide as therapeutic option for congenital idiopathic chylothorax: a case series. Acta Paediatr 101:e151–e155CrossRefPubMedGoogle Scholar
  4. 4.
    Downie L, Sasi A, Malhotra A (2014) Congenital chylothorax: associations and neonatal outcomes. J Paediatr Child Health 50:234–238CrossRefPubMedGoogle Scholar
  5. 5.
    Beghetti M, La Scala G, Belli D et al (2000) Etiology and management of pediatric chylothorax. J Pediatr 136:653–658CrossRefPubMedGoogle Scholar
  6. 6.
    Soto-Martinez M, Massie J (2009) Chylothorax: diagnosis and management in children. Paediatr Respir Rev 10:199–207CrossRefPubMedGoogle Scholar
  7. 7.
    Al-Tawil K, Ahmed G, Al-Hathal M et al (2000) Congenital chylothorax. Am J Perinatol 17:121–126CrossRefPubMedGoogle Scholar
  8. 8.
    Ergaz Z, Bar-Oz B, Yatsiv I, Arad I (2009) Congenital chylothorax: clinical course and prognostic significance. Pediatr Pulmonol 44:806–811CrossRefPubMedGoogle Scholar
  9. 9.
    Lai FC, Chen L, Tu YR et al (2011) Prevention of chylothorax complicating extensive esophageal resection by mass ligation of thoracic duct: a random control study. Ann Thorac Surg 91:1770–1774CrossRefPubMedGoogle Scholar
  10. 10.
    van Straaten HL, Gerards LJ, Krediet TG (1993) Chylothorax in the neonatal period. Eur J Pediatr 152:2–5CrossRefPubMedGoogle Scholar
  11. 11.
    Rocha G (2007) Pleural effusions in the neonate. Curr Opin Pulm Med 13:305–311CrossRefPubMedGoogle Scholar
  12. 12.
    Bialkowski A, Poets CF, Franz AR, Erhebungseinheit fur seltene padiatrische Erkrankungen in Deutschland Study Group (2015) Congenital chylothorax: a prospective nationwide epidemiological study in Germany. Arch Dis Child Fetal Neonatal Ed 100:F169–F172Google Scholar
  13. 13.
    Slater BJ, Rothenberg SS (2015) Thoracoscopic thoracic duct ligation for congenital and acquired disease. J Laparoendosc Adv Surg Tech A 25(7):605–607CrossRefPubMedGoogle Scholar
  14. 14.
    Platis IE, Nwogu CE (2006) Chylothorax. Thorac Surg Clin 16:209–214CrossRefPubMedGoogle Scholar
  15. 15.
    Bellini C, Ergaz Z, Radicioni M et al (2012) Congenital fetal and neonatal visceral chylous effusions: neonatal chylothorax and chylous ascites revisitedA multicenter retrospective study. Lymphology 45:91–102PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Margaret E. Clark
    • 1
  • Russell K. Woo
    • 2
  • Sidney M. Johnson
    • 2
  1. 1.Department of SurgeryTripler Army Medical CenterHonoluluUSA
  2. 2.Department of Pediatric SurgeryKapi’olani Medical CenterHonoluluUSA

Personalised recommendations