Thoracoscopic thoracic duct sealing with LigaSure in two children with refractory postoperative chylothorax.
OBJECTIVE
Chylothorax is an uncommon complication of cardiac surgery. We report two cases of the thoracoscopic management of persistent postoperative chylothorax by thoracic duct thermofusion and section with the LigaSure device.


METHODS
A 6-year-old boy and a 3-year-old girl developed persistent chylothorax following an aortic coarctation repair and a Fontan procedure, respectively. The former presented with a left chylothorax due to direct surgical injury, and the latter, a right chylothorax due to indirect lymphatic rupture secondary to increased venous pressure. In both patients, voluminous chylous drainage persisted for more than 3 weeks despite maximal medical treatment. Ultimately, a right thoracoscopic coagulation and section of the thoracic duct with the 5-mm LigaSure device was performed. The LigaSure is a computer-controlled bipolar diathermy system designed to seal blood vessels up to 7 mm in diameter, with no specific recommendations regarding the lymphatics.


RESULTS
The lymph leakage ceased within 2 days in the first patient and immediately in the second one, with no recurrence after oral intake resumption on day 5. Both patients are free of recurrence at 1 year.


CONCLUSIONS
Thoracoscopic coagulation and section of the thoracic duct above the diaphragm with the LigaSure device appears to be a simple, effective, and safe therapeutic option for treatment of refractory postoperative chylothorax in children.
Khelif
Karim
K
Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, Brussels, Belgium. karim.khelif@huderf.be
Maassarani
Fadi
F
Dassonville
Martine
M
Laet
Marc-Henri De
MH
D001017:Aortic Coarctation / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002916:Chylothorax / Q000601:surgery*; D003972:Diathermy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D013897:Thoracic Duct / Q000601:surgery*; D013906:Thoracoscopy