Surgical management of congenital chylothorax in children

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 (≥50mL/kg/day) needed surgery significantly more often than those with chylothorax 50mL/kg/day. Long-term follow-up is needed to evaluate the potential consequences of this therapy. © Georg Thieme Verlag KG Stuttgart. New York