31. Treatment of Refractory Chylothorax with Externalized Pleuroperitoneal Shunts in Children
Andrew B. Wolff, Mark L. Silen, Evan R. Kokaska and Bradley M. Rodgers
Cardinal Glennon Childrens Hospital, St. Louis, MO and UV, Health System
Charlottesville, Va.
Traditional therapy for refractory chylothorax in the pediatric population has included pleurodesis and thoracic duct ligation - procedures associated with high morbidities and questionable success rates. We report our experience among 15 patients who underwent treatment for chylous effusions employing pleuroperitoneal shunts with exteriorized pump chambers. Mean patient age at time of shunt placement was 2.1 (0.1-11.5) years and the most common indication (7/15) was refractory chylothorax following surgical correction of congenital heart disease. Mean chylothorax duration prior to shunt placement was 76(5-810) days and shunts were in place for an average of 104 (12-365) days. A total of 19 chylous effusions (pleural or pericardial) were treated with shunts. Nine of 11-right-sided, five of six left sided chylothoraces and two of two chylopericardium resolved with shunt therapy (84 percent total). Pleuroperitoneal shunting failed to clear the effusion in three children. There were six episodes of shunt malfunction that were repaired and two episodes of infection. Inguinal or umbilical hernias developed in four patients. Externalized pleuroperitoneal shunting is a safe, effective and minimally invasive treatment for children with refractory chylous effusions.