title: Sixteen years of experience with persistent chylothorax in children.
abstract: BACKGROUND
  Persistent chylothorax in children is rare. Conservative management represents the gold standard but, in case of failure (persistent effusion or relapse), surgery must be considered. This paper aimed at presenting our series of patients who underwent surgical treatment of persistent idiopathic chylothorax and at discussing the role of thoracic duct ligation in its management.
  
  
  METHODS
  We included all patients who underwent surgery for persistent chylothorax in the period between January 1994 and January 2010.
  
  
  RESULTS
  Nine patients were included (median age 25 months). Five patients had primitive or idiopathic chylothorax. Five patients had right-sided chylothorax, 3 left-sided, and 1 bilateral. Pleurodesis was applied to 8 patients (bilateral in one) and thoracic duct ligation to 4 patients for a total of 12 procedures in 9 patients. Complete cessation occurred within a median of 5 days (range 2 to 10) after thoracic duct ligation and 10 days (range 4 to 25) after pleurodesis. In 3 patients (all with right sided effusion and a median daily output higher than 20 ml/kg) pleurodesis failed and thoracic duct ligation was subsequently required to definitively treat chylothorax. Conversely, 5 patients were effectively treated with pleurodesis and 1 with thoracic duct ligation alone. Regardless of previous procedures, none of the patients who underwent thoracic duct ligation experienced relapses.
  
  
  CONCLUSIONS
  Although based on a small number of patients, our experience confirmed that thoracic duct ligation represents an effective therapeutic option for persistent unresponsive chylothorax. In cases of right sided effusion with high output rate (>20 mL/kg) thoracic duct ligation might be considered as first choice treatment.
authors.affiliation: Department of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy - alessiopiniprato@ospedale-gaslini.ge.it.
authors.forename: Alessio
authors.initials: A
authors.lastname: Pini Prato
authors.affiliation: Cardiovascular Department, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Gian L
authors.initials: GL
authors.lastname: Bava
authors.affiliation: Cardiovascular Department, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Dalmonte
authors.affiliation: Cardiovascular Department, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Vercellino
authors.affiliation: Department of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Michelazzi
authors.affiliation: Department of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.|DINOGMI, University of Genoa, Genoa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pio
authors.affiliation: Department of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Avanzini
authors.affiliation: Department of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy.|DINOGMI, University of Genoa, Genoa, Italy.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002916:Chylothorax / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008026:Ligation; D008297:Male; D018700:Pleurodesis / Q000379:methods*; D012189:Retrospective Studies; D013897:Thoracic Duct / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome