A New Technique of Continuous Pleural Irrigation with Minocycline Administration for Refractory Chylothorax

Chylothorax is a rare and serious complication of thoracic surgery and can lead to respiratory insufficiency, protein loss, fluid imbalance, and immunodeficiency. Chylothorax is often difficult and complex to manage. Although multiple approaches for the treatment of chylothorax have been reported, there is still no clear consensus on its optimal management. A surgical approach involving careful dissection and clipping of lymphatic vessels can help effectively manage chylous fistula in a majority of cases. Occasionally, chyle leak may not be apparent during surgery, and thus ligation of the bed of the thoracic duct may not be sufficient to stop the chyle leak. We report here on 3 patients with chylothorax in whom pleurodesis was successfully achieved via continuous intrapleural irrigation with minocycline (800 mg minocycline and 800 mg of 2% lidocaine hydrochloride in 1000 mL normal saline, set to 100 mL per hour) instead of conventional intermittent pleurodesis.