Chylothorax following extended thymectomy for myasthenia gravis

The effectiveness of extended thymectomy for the treatment of myasthenia gravis is well documented. Most of the postoperative complications have been related to respiratory distress or wound complication, but chylothorax following thymectomy has been reported as a rare complication. From January 1995 to December 2004, 217 patients underwent extended thymectomy for myasthenia gravis at Taipei Veterans General Hospital. Three cases (1.38%) developed chylothorax after operation. Injury to the unseen division of the mediastinal lymphatics and branches from the thoracic duct during extensive dissection of perithymic fat tissue, which is seldom performed in classical thymothymectomy procedures, may have been the main cause of this complication. Two of the cases received conservative treatment and recovered uneventfully. The other patient (0.46%) underwent ligation of the thoracic duct 3 months later, which also resulted in the complication being cured. Conclusions: Post-thymectomy chylothorax is rare and seems to be related to extended thymectomy. Even a small invasive procedure such as VATS for extended thymectomy formyasthenia gravis could be complicated by chylothorax. We recommend that if chylothorax develops after thymectomy, conservative treatment is the treatment of choice; however, thoracic duct ligation is a useful method for treating long-term unhealed chylothorax.