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.
Key words
congenital chylothorax - surgical management - pleural abrasion - pleurectomy
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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
