M Fiuza Brito1; A Lunt1; M Dusmet1; H Raubenheimer1; E Loubo1; H Chavan1; S Jordan1; S Padley1; I Ashurst1; P Wright1; M Leung1; E Lim1;
1 Royal Brompton & Harefield Hospitals, UK
ObjectivePost-operative chylothorax is uncommon and there are no consensus guidelines. There are varying management strategies. The aim of this study is to determine the outcomes associated with dietary manipulation with or without concomitant octreotide administration.
MethodThis is a five-year retrospective review of all patients with post-operative chylothorax (2010-2014). Chylothorax was defined as chest drain output of milky white appearance and/or triglyceride concentrations > 1.24mmol/L and cholesterol concentrations < 5.18mmol/L. Key outcome was duration of chest drain. Linear regression was used to evaluate total drainage against method of management and a Kaplan Meier plot was constructed to display the duration of chest drainage.
ResultsDuring the study period a total of 11,085 thoracic surgical procedures were performed; there were 25 cases of chylothorax (0.23%). In 13 patients (52%) the diagnosis was confirmed by pleural fluid analysis. All 25 received dietary manipulation (diet with <10g/day long chain triglyceride and medium chain triglycerides or TPN in 1). Five patients were switched to total parenteral nutrition (TPN). Octreotide was prescribed to 9 patients (3/6 patients with TPN). Chylothorax resolved with dietary manipulation in 22 patients (88%). TPN was associated with an increase in drain output (130 ml; p=0.44) and octreotide with a decrease (60 ml; p=0.73). Chest drainage was longer in the TPN group (p=0.03). Three patients underwent surgical repair following a period of dietary manipulation. Initial drain output did not reliably predict the need for additional intervention; rather persistent high output was associated with the decision for further surgery.
ConclusionInitial conservative therapy with oral dietary manipulation resulted in acceptable drain duration and can be considered as first line therapy in post-operative chylothoraces (even if output is initially high).