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Post-operative chylothorax in children: An evidence-based management algorithm

Authors

  • Charnchai Panthongviriyakul,

    1. Murdoch Childrens Research Institute,
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  • Julie E Bines

    1. Murdoch Childrens Research Institute,
    2. Department of Paediatrics, University of Melbourne, Victoria, Australia;
    3. Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia
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Professor Julie Bines, Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Vic. 3052, Australia. Fax: +613 9345 6667; email: julie.bines@rch.org.au

Abstract

Aim:  To develop an evidence-based algorithm for the therapeutic approach to the management of post-operative chylothorax.

Methods:  Review and analysis of published literature sourced from Medline from 1964–2007.

Results:  Understanding the pathophysiology of chylothorax and the anatomical structure of the thoracic duct assisted clinical decision making in the management of a patient with chylothorax. Treatment options for post-operative chlothorax include conservative management with medium chain triglyceride-enriched diet or total parenteral nutrition in combination with adequate drainage of pleural fluid, somatostatin or octreotide therapy or surgical intervention. Based on analysis of the available evidence an algorithm for therapeutic approach to the management of post-operative chylothorax has been developed.

Conclusion:  Post-operative chylothorax is associated with significant morbidity and prolonged hospitalization. An evidence based algorithm to guide the therapeutic approach to management of post-operative chylolthorax is proposed.

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