Alamdari DH, et al. - Authors here evaluated the efficacy of pleurodesis with a combination of platelet-rich plasma (PRP) and fibrin glue to the treatment of chylothorax after trans-hiatal esophagectomy. Pleurodesis using PRP and fibrin glue for chylothorax after trans-hiatal esophagectomy seemed associated with significantly increased success rate, decreased ICU stay, decreased overall hospital stay, and decreased mortality compared with surgical thoracic duct ligation. There was no patient after PRFG who required additional intervention including surgery. Thus, in view of the improved outcomes with PRFG pleurodesis, this technique could be considered in all patients with postoperative chylothorax after or during conservative management and before proceeding to more invasive interventions.

Methods

• Random allocation was performed of 52 consecutive esophageal cancer patients with postoperative chylothorax who did not respond to conservative management to either PRP fibrin glue pleurodesis or surgical thoracic duct ligation.
• To control chylothorax, 26 patients in each group were treated with PRP fibrin glue pleurodesis or surgical thoracic duct ligation.
• Authors analyzed perioperative data including success rate and complications of both interventions.

Results

• Regarding patients’ demographics and tumor characteristics, groups were similar.
• Successful treatment was observed in all 26 patients in pleurodesis group (100%) and 20 patients in surgery group (76.9%) (p = 0.009).
• A second application of PRP fibrin glue was required in seven patients (26.92%) in pleurodesis group after a week.
• The mean length of hospital stay in surgery group was 53.50 ± 16.662 days and in pleurodesis group was 36.04 ± 8.224 days (p < 0.001).
• Although higher mortality rate was evident in surgery group in comparison to pleurodesis group, it was not statistically significant (p = 0.1621).
• Findings revealed no significant difference in complications between two groups either.
• There appeared no serious side effect with PRP fibrin glue application.