Postoperative chylothorax in patients with a thoracic aortic aneurysm.
OBJECTIVE
Postoperative chylothorax in patients with a thoracic aneurysm is generally infrequent. We report a mode of surgery to reduce the incidence of paraplegia. We review our experience with chylothorax after resection of an aneurysm to find its cause and to evaluate the success of management.


METHODS
For descending thoracic aneurysms, intercostal arteries in the aneurysm were exposed before incising the aneurysm and, they were only sacrificed no change in motor-evoked potentials (MEPs) occurred after temporary occlusion. Between January 2001 and December 2003, out of a total of 147 aneurysms including thoracic and thoracoabdominal, 4 consecutive patients (2.7%) with chylothorax were reviewed.


RESULTS
The chylothorax was diagnosed 1.5 days after operation (range 1 to 2 days). All patients were initially treated by the cessation of oral intake. This treatment was successful for 2 patients and the remaining 2 required surgical intervention to control the fistula. Chylothorax was cured in all patients.


CONCLUSIONS
We postulate that chylothorax is caused by injury of the thoracic duct or its branch during the exposing the intercostal arteries. In the management of chylothorax, early intervention is recommended when the volume of chylous fluid is not decreased by conservative treatment.
Minami
Hiroya
H
Department of Cardiovascular Surgery, Himeji Cardiovascular Center, Himeji, Japan.
Mukohara
Nobuhiko
N
Shida
Tsutomu
T
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D015505:Chest Tubes; D002916:Chylothorax / Q000209:etiology / Q000628:therapy*; D004750:Enteral Nutrition; D019054:Evoked Potentials, Motor / Q000502:physiology*; D006801:Humans; D008297:Male; D008485:Medical Audit; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome