Chylothorax after mediastinal ganglioneuroma resection treated with fibrin sealant patch: a case report

Thoracoscopic Management of Chylothorax by Application of a Fibrin Sealant Patch

Thoracic duct ligation is a demanding procedure when the chyle leak and/or the duct itself are not identified. This report describes a new procedure using thoracoscopic closure of the chyle leak by application of a fibrin sealant patch. This strategy was successfully applied for closing (i) a small fistula due to a postoperative lesion of the lymphatic tributary vessels in one case, and (ii) a large fistula due to idiopathic rupture of the thoracic duct in another case.

Chylothorax After Schwannoma Resection

Schwannomas are tumors derived from Schwann cells of the peripheral nerve sheath that are usually benign; nonetheless, they can cause significant morbidity. When indicated, surgical resection is the gold standard of treatment for schwannomas. However, chylothorax is a rare postoperative complication of thoracic surgery. We present a case of chylothorax after thoracic schwannoma resection. A 61-year-old woman underwent a computed tomography (CT) scan for suspected nephrolithiasis, which instead found a right mediastinal mass that was confirmed to have features consistent with a schwannoma on thoracic spine magnetic resonance imaging (MRI). Right thoracotomy and schwannoma resection were performed, resulting in the complete removal of the schwannoma without capsular invasion. Two chest tubes were also inserted. On postoperative day 1 (POD1), the patient presented with a chylothorax that was initially treated with chest tube suctioning and total parenteral nutrition (TPN). However, a repeat right thoracotomy with thoracic duct ligation and dry talc chemical pleurodesis was subsequently performed on POD15 due to a lack of clinical improvement, which saw the resolution of the chylothorax without recurrence. Chylothorax is a rare but severe postoperative complication of thoracic surgeries, including those that involve tumor resections. We present a case of chylothorax after thoracic schwannoma resection that initially failed conservative management but eventually resolved after thoracic duct ligation and chemical pleurodesis. This case highlights the need for effective non-surgical treatments for chylothorax, the importance of remaining vigilant for rare postoperative complications, and the need for randomized controlled trials (RCTs) to develop a standardized chylothorax management algorithm.

Platelet-rich plasma fibrin glue for treatment of chylothorax following cavopulmonary connections

OBJECTIVES

The postoperative persistence of chylothorax is a fatal complication of paediatric cardiac surgery. There is an urgent need for an effective treatment of chylothorax. This study reports the application of allogenic platelet-rich plasma fibrin glue (PRP-FG) as a conservative therapy before reoperation.

METHODS

Over a 9-year period, from 2010 to 2019, 27 patients with persistent chylothorax following a cavopulmonary connection, with a mean latency period of 11 days (range 10-15 days), were treated with PRP-FG. These patients were selected because they had not responded positively to initial conservative management plans. The patients were followed up for 9 years.

RESULTS

Twenty-five patients (92%) responded positively to treatment with PRP-FG; 2 patients did not respond to the treatment and died after reoperation. All of the successfully treated patients in follow-up continued to live a healthy life without further complications.

CONCLUSIONS

Recalcitrant chylothorax that persists after paediatric cardiac surgery responded positively to treatment with PRP-FG. This technique precluded the need for another operation and significantly decreased the morbidity and mortality rates.

Analysis of the etiology and treatment of chylothorax in 119 pediatric patients in a single clinical center

PURPOSE

To summarize the etiology and treatment of 119 patients with chylothorax in our hospital.

METHODS

A total of 119 patients with chylothorax, divided into a neonate group, an infant group, and an older-than-1-year group, were included in our study and analyzed from January 2000 to July 2017 in the Children's Hospital of Chongqing Medical University.

RESULTS

A total of 90 males and 29 females were included in our study. In the neonate group, 21 chylothorax cases were due to idiopathic factors, constituting 72.4% of the cases; 8 were related to cardiothoracic surgery, constituting 27.6%. In the infant group, 15 chylothorax cases were due to cardiothoracic surgery, constituting 55.6% of the cases; 11 were related to idiopathic factors, constituting 40.7%; and 1 was related to lymphoma, constituting 3.8%. In the older-than-1-year group, 33 chylothorax cases were due to idiopathic factors, constituting 52.4% of the cases; 25 were cardiothoracic surgery, constituting 39.7%; 2 were related to another internal medicine disease, constituting 3.2%; 2 were due to injury, constituting 3.2%; and 1 was related to lymphoma, constituting 1.6%. All the patients sequentially underwent thoracic drainage therapy, followed by fasting, thoracic injection of an adhesion-promoting agent, and thoracic duct ligation surgery. Among the neonates, 23 patients (79%) with fasting therapy improved, and 5 patients with fasting + intrapleural injection improved (17%). In the infant group, fasting promoted recovery in 14 patients, accounting for 51%, and fasting + thoracic injection improved the conditions of 10 patients, accounting for 37%. In the older-than-1-year group, fasting was effective in 35 patients, accounting for 55%; fasting + thoracic injection was effective in 22 patients, accounting for 34%; and fasting + thoracic injection + thoracic duct ligation surgery enabled the recovery of 2 patients, accounting for 3.2%.

CONCLUSION

In our center, the main causes of chylothorax in the neonates group are idiopathic factors but may also include a history of unspecified birth trauma; the proportions of idiopathic factors in the infant and older-than-1-year groups are also higher, but the iatrogenic factors are significantly increased in the latter 2 groups. All the patients underwent thoracic drainage therapy, and fasting promoted the recovery of most children. When fasting was ineffective, subsequent thoracic injections were effective. If the above two methods failed, surgery was a method of choice, but it was not always effective.

LEVEL OF EVIDENCE

Level IV.

TYPE OF STUDY

Retrospective study.

Use of Tachosil® as an adjuvant therapeutic option in neurotrophic keratopathy in order to prevent perforation

We present two cases of women who suffered from neurotrophic keratopathy (one of them had undergone penetrating keratoplasty) which had led to corneal thinning. Tachosil^® was used as an adjuvant treatment after topical medication by itself failed in both cases. To our knowledge, there are no reported cases of the use of Tachosil^® in corneal grafts.