Thoracoscopic Repair for Postoperative Chylothorax Using Tissue Sealing Sheet, Polyglycolic Acid Sheet, and Fibrin Glue in a Boy With Malignant Mediastinal Germ Cell Tumor

Abstract

A 3-year-old boy with malignant germ cell tumor in the left anterior mediastinum underwent total tumorectomy via median sternotomy after chemotherapy. His chest tube drained chylous pleural effusion immediately after surgery. Chylothorax was intractable to conservative treatments such as fat restriction and octreotide infusion. Eleven days after the first surgery, a thoracoscopic approach was performed. The injury site of the main thoracic duct was located behind the aortic arch, and direct clipping was impossible. Therefore, we sealed the injury site with a TachoSil^® fibrin sealant patch. We confirmed that the leakage of chylous effusion stopped and then we reinforced with both a polyglycolic acid sheet and fibrin glue. The patient was symptom-free immediately after the second surgery. Thoracoscopic repair using a tissue-sealing sheet, a polyglycolic acid sheet, and fibrin glue was a simple, invasive, and feasible method for postoperative chylothorax.