Thoracoscopy in the Management of Chylothorax

Abstract

The management of chylothorax has undergone a series of changes in the past decade. Current practice includes nonoperative treatment with low-fat dietary manipulation, pleuroperitoneal shunting procedures, and the direct operative approach to the thoracic duct. Medical management should be used initially but should not be continued for extended periods of time. We have felt that after 1 week of medical therapy, the risks of sepsis and malnutrition outweigh the risk of intervention. The shunting procedures have been successful in managing conditions that are associated with widespread lymphatic leak such as postoperative chylothorax with wide mediastinal dissection and lymphangiomatosis. Thoracoscopic procedures are most successful in the management of the discrete thoracic duct injury, including posttraumatic injuries and congenital chylothorax. The thoracoscopic approach to chylothorax appears to be as effective as thoracotomy, while offering the benefits of minimally invasive procedures.