title: Management of chylothorax in adults: when is surgery indicated?
abstract: BACKGROUND
  The aim of this retrospective study was to analyze the etiology, management and outcome of patients with chylothorax and identify clinical parameters for appropriate treatment decisions.
  
  
  METHODS
  We analyzed 82 cases of chylothorax in 75 patients. In 37 cases (45 %) the cause of chylothorax was surgery, in 45 cases (55 %), the etiology was nonsurgical (malignancy n = 17 [21 %], lymphatic disorders n = 5 [6 %], hepatic cirrhosis, n = 4 [5 %], trauma n = 1 and other causes n = 18 [22 %]).
  
  
  RESULTS
  Conservative treatment was successful in 13 (16 %) cases. In 25 cases (total 31 %, postsurgical n = 19 [51 %], nonsurgical n = 6 [13 %]) a (redo) thoracotomy with ligation of the thoracic duct or repeat surgical procedure was performed. The quantity of chyle drained per 24 hours appeared to be the best indicator to guide management decisions.
  
  
  CONCLUSIONS
  Chylothoraces that occur postoperatively following thoracic procedures require redo operations in approximately 50 % of cases, whereas nonsurgical causes rarely require surgical intervention. In postoperative chylothoraces with a high flow leak > 900 mL/24 h revision should be performed early on, since conservative management is likely to be unsuccessful.
authors.affiliation: Department of Thoracic Surgery, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany. heike.zabeck@thoraxklinik-heidelberg.de
authors.forename: H
authors.initials: H
authors.lastname: Zabeck
authors.forename: T
authors.initials: T
authors.lastname: Muley
authors.forename: H
authors.initials: H
authors.lastname: Dienemann
authors.forename: H
authors.initials: H
authors.lastname: Hoffmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D002916:Chylothorax / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D004322:Drainage / Q000295:instrumentation; D005260:Female; D005858:Germany; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D018579:Patient Selection; D018700:Pleurodesis; D012086:Reoperation; D012189:Retrospective Studies; D013897:Thoracic Duct / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D016896:Treatment Outcome