[Management of postoperative chylothorax].
BACKGROUND
A chylothorax can occur following any intrathoracic procedure. It is generally straightforward to make the diagnosis but optimal management can be problematic.


METHODS
Between 1995 and 2002, three women and one man aged from 13 to 58 years were treated for chylothorax after thoracic surgery. Their initial illnesses were a right pulmonary hydatid cyst associated with hepatic disease, a tumour of the posterior mediastinum, an oesophageal carcinoma and metastases in the left lung.


RESULTS
These patients had: a pulmonary and hepatic cystectomies, a resection of the mediastinal tumor, an Akyama oesophagectomy and a resection of four left pulmonary metastases. Chylothorax became apparent post operatively between the 1st and the 4th day. All patients were treated with a medium-chain triglyceride diet. Two patients were re-explored with ligation of lymphatic vessels. One woman who did not have further surgery was treated with etilefrine. In the patient who had had an oesophagectomy, chylothorax persisted after re-operation. He was successfully treated by talc pleurodesis via a chest drain, which prevented further recurrence.


CONCLUSIONS
In the management of postoperative chylothorax, medical treatment must be started early but surgery should not be delayed as operative risk is increased by the development of malnutrition and immune deficiency.
Smati
B
B
Service de chirurgie thoracique et cardiovasculaire, Hôpital Abderrahmen MAMI. Ariana, Tunisie. belhassen_smati@yahoo.fr
Sadok Boudaya
M
M
Marghli
A
A
Mestiri
T
T
Baccari
S
S
Hantous
T
T
Djilani
H
H
Kilani
T
T
D000293:Adolescent; D000322:Adrenergic Agonists / Q000627:therapeutic use*; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery; D019090:Case Management; D002916:Chylothorax / Q000178:diet therapy / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D004041:Dietary Fats / Q000008:administration & dosage*; D004044:Dietary Proteins / Q000008:administration & dosage; D004322:Drainage; D004444:Echinococcosis, Hepatic / Q000601:surgery; D004445:Echinococcosis, Pulmonary / Q000601:surgery; D002149:Energy Intake; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D005039:Etilefrine / Q000627:therapeutic use*; D005260:Female; D005729:Ganglioneuroma / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008026:Ligation; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000178:diet therapy / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012086:Reoperation; D013897:Thoracic Duct / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D019616:Thoracic Surgical Procedures; D014280:Triglycerides / Q000008:administration & dosage*
D000322:Adrenergic Agonists; D004041:Dietary Fats; D004044:Dietary Proteins; D014280:Triglycerides; D005039:Etilefrine