J Pediatr Surg
. 2022 Dec 5;S0022-3468(22)00771-0.
doi: 10.1016/j.jpedsurg.2022.11.018. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/36609065/
Management of congenital and postoperative chylothorax: Use of thoracoscopic lymphatic leak ligations with intraoperative ICG lymphangiography
Shunya Takada 1, Chiyoe Shirota 1, Hiroo Uchida 2, Hizuru Amano 1, Akinari Hinoki 3, Wataru Sumida 1, Satoshi Makita 1, Masamune Okamoto 1, Aitaro Takimoto 1, Akihiro Yasui 1, Youichi Nakagawa 1, Daiki Kato 1, Yaohui Guo 1, Takahisa Tainaka 1
- PMID: 36609065
- DOI: 10.1016/j.jpedsurg.2022.11.018
Background: Congenital chylothorax (CCT) and postoperative chylothorax (POCT) are rare and difficult to treat. We report our treatment strategy and outcomes for chylothorax, including thoracoscopic surgery with indocyanine-green (ICG) near-infrared fluorescence lymphangiography.
Methods: A retrospective review of patients with CCT and POCT from 2014 to 2021 was performed. After definitive diagnosis, conservative treatments with octreotide, followed by intravenous steroids as needed, were performed. Patients who were refractory to conservative treatment were transferred to surgical treatment, consisting of thoracoscopic lymphatic leak ligations using ICG intraoperative lymphangiography. The effectiveness of conservative and surgical treatment was then examined.
Results: We included 19 cases of CCT and 31 cases of POCT. The 31 POCT patients included 23 of 84 postoperative patients with congenital diaphragmatic hernia (CDH), 7 of 54 postoperative patients with esophageal atresia (EA), and 1 of 3 postoperative patients with lymphatic malformation. The efficacy of conservative treatment was 12/19 for CCT, 22/23 for CDH, and 4/7 for EA. Surgical intervention was performed in 10 patients, and the rate of resolution of chylothorax within 3 weeks after surgery was 90%.
Conclusion: Thoracoscopic lymphatic leak ligations with intraoperative ICG lymphangiography are feasible and useful in patients with chylothorax refractory to conservative treatment.
Level of evidence: Level IV.
Keywords: Chylothorax; Congenital; Indocyanine-green; Near-infrared fluorescence surgery; Octreotide; Postoperative; Thoracoscopic navigation surgery.
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