Eur J Pediatr Surg 2010; 20(5): 307-311
DOI: 10.1055/s-0030-1254164
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Surgical Management of Congenital Chylothorax in Children

R. Le Nué1 , F. Molinaro1 , C. Gomes-Ferreira1 , C. Scheib-Brolly2 , B. Escande2 , P. Kühn2 , I. Lacreuse1 , R. Favre3 , F. Becmeur1
  • 1University Hospital of Strasbourg, Department of Pediatric Surgery, Strasbourg, France
  • 2University Hospital of Strasbourg, Neonatal Intensive Care Unit, Strasbourg, France
  • 3University Hospital of Strasbourg, Obstetrics and Gynaecology, Strasbourg, France
Further Information

Publication History

received December 21, 2009

accepted after revision April 05, 2010

Publication Date:
24 June 2010 (online)

Abstract

Purpose: Aim of the study was to determine the role of surgery in the management of congenital chylothorax (CC).

Methods: We retrospectively reviewed the data of patients with CC requiring medical or surgical treatment postnatally in our institution between January 2001 and March 2009.

Results: Ten patients were treated for CC. We divided our population into 2 groups: group A consisted of patients in whom CC healed after conservative medical treatment (thoracocentesis, pleural drainage, total parental nutrition, somatostatin, intrapleural injections of povidone-iodine), and group B of patients who needed both medical and surgical treatment (pleural abrasion and/or pleurectomy). Conservative postnatal therapy was successful in 50% of cases. Of the 3 patients treated preoperatively with intrapleural injections of povidone-iodine, 2 presented with severe complications. Surgical treatment was successful in all cases, with no surgical complications. Patients in group B had a significantly lower birth term (p=0.0254) and birth weight (p=0.0021) compared to patients in group A. Patients with a massive chylothorax (≥50 mL/kg/day) needed surgery significantly more often than those with chylothorax <50 mL/kg/day (p=0.0119).

Conclusion: The initial postnatal medical management of CC should consist of thoracocentesis, drainage by tube thoracostomy, and total parenteral nutrition. If this treatment fails after 10 days, we propose using alternative therapies such as somatostatin (although its efficacy is not clear) and surgery. Chemical pleurodesis by intrapleural injection of povidone-iodine must be avoided in infants and small babies. Surgical management by pleural abrasion and/or pleurectomy appears to be safe and effective. Early surgical management is proposed for babies with low birth term, birth weight and massive chylothorax >50 mL/kg/day. Long-term follow-up is needed to evaluate the potential consequences of this therapy.

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Correspondence

Rachel Le Nué

Hôpitaux Universitaires de

Strasbourg

Service de Chirurgie Pédiatrique

Hôpital de Hautepierre

67200 Strasbourg

France

Phone: +33 631 05 44 85

Fax: +33 388 12 72 95

Email: ln.rachel@gmail.com

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