Management of chylothorax after thoracoscopic splanchnicectomy.
Thoracoscopic splanchnicectomy is a minimally invasive procedure used in the treatment of recalcitrant abdominal pain in patients with chronic pancreatitis or pancreatic carcinoma. Chylothorax, an uncommon complication of thoracoscopic splanchnicectomy, may lead to a protracted, costly hospital course of treatment usually consisting of central venous hyperalimentation, restricted oral intake, and tube thoracostomy. In our series of 25 patients who underwent thoracoscopic splanchnicectomy, 2 developed postoperative chylothorax. Both patients failed conservative management and ultimately underwent operative reintervention, at which time, leaking lymphatics were easily identified and closed using minimally invasive techniques. On the basis of this experience, we advocate early thoracoscopic reintervention in patients with chylothorax after thoracoscopic splanchnicectomy.
Selzer
D J
DJ
Department of Surgery, Indiana University School of Medicine, Indianapolis 46202, USA. DJSelzer@aol.com
Howard
T J
TJ
Kesler
K A
KA
D015746:Abdominal Pain / Q000601:surgery; D000328:Adult; D001013:Aorta, Thoracic; D002908:Chronic Disease; D002916:Chylothorax / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008482:Mediastinum / Q000098:blood supply / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010195:Pancreatitis / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D013153:Splanchnic Nerves / Q000601:surgery*; D013897:Thoracic Duct / Q000601:surgery; D013906:Thoracoscopy / Q000009:adverse effects*; D014680:Veins