Surgical management of chylothorax after pulmonary resection

: Chylothorax is a rare severe complication after general thoracic surgery. Recent advances of energy devices and limited pulmonary resection for early stage lung cancer decrease postoperative chylothorax. At an early stage, conservative treatment, such as chest tube drainage and reducing chyle flow by total elimination of oral or enteral fat intake should be initiated. When chyle flow continues 500~1,000 ml/day for 5 days or cardiopulmonary complications, immunodeficiency or malnutrition due to prolonged chylothorax are expected, surgical ligation of thoracic duct becomes the treatment option. After identification of wound localization by preoperative lymphangiography, direct wound ligature or en masse supradiaphragmatic ligature are recommended. Pre- or intraoperative ingestion of fatty substances via a nasogastric tube can facilitate wound localization by increasing the flow. Thoracoscopy is useful for searching the leaking point of chyle in detail. Due to the problems encountered with localizing wounds of thoracic duct, techniques have been developed to ligature the duct upstream, at its entry into the thorax. This wide ligature guarantees full ligature with close to 95% success rate. A chest tube can be removed immediately after reduction of pleural effusion less than 200 ml/day.