Thoracoscopic Ligation of the Thoracic Duct for Persistent Chylothorax After Pediatric Cardiac Surgery—Outcomes of a Standardized Technique

Abstract

Background

Chylothorax, the accumulation of triglyceride-rich fluid in the pleural cavity, is a well-recognized complication after surgery for congenital heart disease in children. Treatment protocols and role of surgery are not standardized.

Objective

This study aims to evaluate the outcomes of a standardized technique of thoracoscopic ligation of the thoracic duct (TLTD), for the management of persistent chylothorax following pediatric cardiac surgery.

Methods

A longitudinal study was conducted on children diagnosed with postoperative chylothorax at a single center from 2018 to 2024. Children who required surgery were included in the study. Data on demographics, treatment timelines, and outcomes were collected and analyzed.

Results

Out of 11,429 children who underwent cardiac surgery, 24 children (median age of 33.5 months) required surgery for persistent chylothorax. Thoracoscopic ligation of the thoracic duct was typically performed on day 7 after diagnosis. Chylothorax resolved in 23 out of 24 cases by a median of 10 days following TLTD. The procedure caused minimal morbidity, and no significant procedure-related complications. There were two deaths due to poor cardiac function despite resolution of chylothorax.

Conclusion

Thoracoscopic ligation of the thoracic duct is a safe and effective technique for persistent chylothorax in children following cardiac surgery. This standardized technique is reproducible and its timely application enhances recovery and reduces hospital stay. Further research will define the role of this technique in overall management of chylothorax postcardiac surgery.