Use of video-assisted thoracic surgery in the treatment of chylothorax.
Chylothorax, a potentially lethal disorder that may cause profound respiratory, nutritional, and immunologic complications, has become increasingly common in recent years. Medical therapy has been found to have a significant failure rate. Therefore, surgical treatment of complicated chylothorax has become a mainstay of care. Between 1987 and 1993, ten patients at the University of Virginia Hospital were treated with video-assisted thoracic surgery for complicated chylothorax. Twelve thoracoscopic procedures were performed. Patients ranged in age from 7 months to 82 years. Causes included iatrogenic (2), congenital (2), caval thrombosis (2), amyloid (2), blunt trauma (1), and metastatic carcinoid tumor (1). In 10 cases, video-assisted thoracic surgery was employed as the principal mode of therapy: 8 using talc pleurodesis alone, 1 using talc pleurodesis and clipping of the thoracic duct with application of fibrin glue, and 1 requiring clipping of a pleural defect with application of fibrin glue. In 2 cases, a video-assisted thoracic operation was used in conjunction with pleuroperitoneal shunting: a previously placed pleuroperitoneal shunt that was malfunctioning was repositioned thoracoscopically after a pleural adhesiolysis, and a pleural adhesiolysis was performed thoracoscopically before placement of a pleuroperitoneal shunt. In all cases the effusion resolved after the video-assisted thoracic operation without further intervention. Video-assisted thoracic surgery offers an effective means of treating chylothorax, regardless of cause, allowing the advantage of access to thoracic structures without the morbidity of more extensive procedures.
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908.
D D
DD
Graham
E D
ED
McGahren
C G
CG
Tribble
T M
TM
Daniel
B M
BM
Rodgers
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D002916:Chylothorax / Q000601:surgery*; D004322:Drainage; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery; D010994:Pleura / Q000601:surgery; D010995:Pleural Diseases / Q000601:surgery; D013627:Talc / Q000627:therapeutic use; D013897:Thoracic Duct / Q000601:surgery; D013906:Thoracoscopy; D000267:Tissue Adhesions / Q000601:surgery; D014741:Video Recording
D015718:Fibrin Tissue Adhesive; D013627:Talc