Management of postoperative chylothorax

Abstract

Chylothorax is a rare but severe complication of thoracic and esophageal surgery. The anatomical relations of the thoracic duct and its highly variable anatomy may explain the occurrence of thoracic duct injury during dissection of the posterior mediastinum. At an early stage, chylothorax can lead to severe cardiorespiratory and volemic complications. In case of chronicization, malnutrition and immunologic complications can occur, responsible for a mortality rate of up to 50%. Optimal management of chylothorax can decrease mortality. It is based on three options: conservative treatment, surgery and radiological treatment. Conservative treatment must be initiated at diagnosis and results in resolution of the chylothorax is achieved in 50 to 70% of cases. In case of either high flow rate chylothorax or failure of conservative treatment, reoperation is indicated. Percutaneous embolization is an interesting and minimally invasive alternative to surgery.