BACKGROUND/AIMS

We reviewed our experience with iatrogenic chylothorax after general thoracic surgical procedures to identify factors that predict the need for reoperation and to evaluate the success of management.

MATERIAL and METHODS

Between January 2010 and July 2018, 3,640 general thoracic surgical procedures were performed at our institution, and iatrogenic chylothorax developed in 19 patients. The medical records of these 19 patients were reviewed for age, sex, preoperative history, operative and pathologic findings, amount of daily chest tube (CT) output, and method of management of the chylothorax. We compared the differences in triglyceride value, triglyceride/cholesterol rate, the CT output for the daily before reoperation, and the first 24 hours and 5 post-operative days between the conservatively cured group and reoperation group.

RESULTS

Pulmonary operations were performed in 14 patients, mediastinal operations were performed in four, and esophageal operation was performed in one. All patients were initially treated by complete cessation of oral intake and total parenteral nutrition, talc pleurodesis, and somatostatin. This treatment was successful for 12 patients. The remaining seven patients (36.8%) required reoperation to control the chylothorax. There were significant differences between the conservatively cured group and reoperation group for CT output for the first 24 hours and 5 days and triglyceride/cholesterol rate.

CONCLUSION

The CT output greater than 950mL day1 for the first day or 1,000mL day1 for the first 5 days and the development of a chylothorax after an esophageal operation are significant factors that predicted the need for reoperation.

Keywords: Iatrogenic chylothorax, management, reoperation