Bethany J Slater, Steven S RothenbergThe Rocky Mountain Hospital for ChildrenDenver, Colorado
¨Steven S. Rothenberg, MD¡Ownership interest in JustRight Surgical
¨Congenital¨Acquired¡Trauma¡Post-operativeúCardiac surgery
¨Chest tube¡Drain chyle from pleural space¨NPO¡Decrease production of lymph flow¨Octreotide
¨High failure rate¨Chyle loss:¡Nutritional¡Metabolic¡Immunologic abnormalities
¨Persistent drainage¨Complications from chyle loss¨Ligation of thoracic duct¡Posterolateral thoracotomyúSignificant post-operative painúChest wall deformityúDifficult to visualize¡ThoracoscopicúMinimally invasiveúMagnification
¨30 Pts¨15 yrs (June 1999 –September 2014)¨Age: 3 wks – 5 yrs¨Wt: 2.6 - 12.7 kg
¨3 Ports¨4 mm: 30 degree camera¨3 mm: left hand instrument¨3mm or 5mm: tissue sealer¡Suture ligature
Thoracic Duct
¨All completed thoracoscopically¡No conversions to open¨No intra-operative complications¨Operative Time: 20-55 mins¨CT duration: 4-14 days¨1 pt w congenital bl chylothoracies required a second procedure w L partial pleurectomy ¨3 pts failed ligation¡2 Thoracoscopic pleurectomy¡Chemical pleurodesis
¨Safe and effective procedure¡Even in post-cardiac surgery pts¨Site of leak can be identified in majority of cases¨Tissue sealing technology appears to be effective in sealing the duct¨May warrant earlier surgical intervention ¡avoid the often chronic and debilitating fluid and protein losses associated with a major chyle leak