Thoracoscopic pleural clipping for the management of congenital chylothorax.
OBJECTIVE
Medical management of congenital chylothoraces consists of total parental nutrition and tube thoracostomy. However, these infants are exposed to significant fluid shifts and the related leukopenia carries a high infection risk. The purpose of this review is to describe the technique of parietal pleural clipping as a surgical treatment of congenital chylothorax.


METHODS
The medical records of all patients with a chylothorax diagnosis during the study period of January 2002 to April 2014 were retrospectively reviewed.


RESULTS
Six of 14 infants identified underwent thoracoscopic parietal pleural clipping to disrupt the pleural lymphatic channel flow as visualization of the thoracic duct and lymphatics was not possible. Nearly all surgical patients had bilateral disease (5/6). Resolution of chylous leakage was dramatic following parietal clipping. In the surgical patients, chest tube output 2 days prior to surgery averaged 86.96 ml/kg/day. After parietal clipping, chest tube output dropped to an average of 6.5 ml/kg/day on post op day 2. Thereafter, chest tube output remained low to negligible and chest tubes were removed variably as enteral feeds were started.


CONCLUSIONS
We describe a straightforward technique of thoracoscopic parietal pleural clipping as a safe and successful option for treatment of congenital chylothoraces.
Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, USA. margaret.elise.clark@gmail.com.
Margaret E
ME
Clark
Department of Pediatric Surgery, Kapi'olani Medical Center, Honolulu, HI, USA.
Russell K
RK
Woo
Department of Pediatric Surgery, Kapi'olani Medical Center, Honolulu, HI, USA.
Sidney M
SM
Johnson
D002916:Chylothorax / Q000151:congenital* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010994:Pleura / Q000601:surgery*; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
Chyle leak; Chylothorax; Neonate; Parietal clipping; Pleurodesis; Thoracic duct