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.
Graham
D D
DD
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908.
McGahren
E D
ED
Tribble
C G
CG
Daniel
T M
TM
Rodgers
B M
BM
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