Chylothorax after congenital diaphragmatic hernia repair.
OBJECTIVE
Chylothorax after congenital diaphragmatic hernia (CDH) repair contributes significantly to morbidity. Our aim was to identify factors contributing to chylothorax and effective treatment strategies.


METHODS
We reviewed 171 patients with CDH from 1997 to 2008 and analyzed hernia characteristics, extracorporeal membrane oxygenation (ECMO) use, operative details, and treatment approaches for chylothorax.


RESULTS
Ten (7%) patients developed chylothorax; all were left sided. Using univariate analysis, prenatal diagnosis, ECMO use, and patch repair were associated with development of chylothorax. Logistic regression analysis showed that patch repair was the only variable predictive of chylothorax (P = .028; confidence interval, 0.032-0.823). Although survival was not affected, patients with chylothorax had a significant increase in ventilator days and length of stay (t = 3.57; P = .000; t = 2.74; P = .007). All received thoracostomy and total parenteral nutrition. Six patients received octreotide, 5 of whom required pleurectomy because of failed medical management; the remaining patient died of overwhelming sepsis.


CONCLUSIONS
The incidence of chylothorax at our institution was relatively low. Patch repair was associated with the formation of chylothorax. Morbidity was substantial, but survival was not significantly affected. Total parenteral nutrition and thoracostomy were appropriate initial treatments. Octreotide was not an effective adjunct. Refractory cases were successfully treated with pleurectomy.
Gonzalez
Raquel
R
Section of Pediatric Surgery, Department of Surgery, University of Michigan Medical School, The CS Mott Children's Hospital, Ann Arbor, MI 48109, USA.
Bryner
Benjamin S
BS
Teitelbaum
Daniel H
DH
Hirschl
Ronald B
RB
Drongowski
Robert A
RA
Mychaliska
George B
GB
D002916:Chylothorax / Q000209:etiology* / Q000628:therapy*; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors