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Surgical Endoscopy

, Volume 22, Issue 12, pp 2742–2742 | Cite as

Prone thoracoscopic thoracic duct ligation for postsurgical chylothorax

  • Peter M. DenkEmail author
  • Prakash Gatta
  • Lee L. Swanström
Video

Abstract

Background

Chylothorax after complex abdominal and thoracic procedures remains a challenging complication with a mortality rate reaching 50% if untreated [1]. Iatrogenic trauma accounts for almost 20% of all chyle leaks, and esophagectomy is the most common iatrogenic cause [2]. Consequences of ongoing chyle leak include dehydration, malnutrition, and immunocompromise.

Methods

When nonoperative management techniques fail, prompt ligation of the thoracic duct at the diaphragmatic hiatus should be attempted. The authors present prone thoracoscopic thoracic duct ligation performed for two patients after laparoscopic transthoracic esophagectomy and revision paraesophageal hernia repair.

Results

The prone position for thoracoscopic thoracic duct ligation offers several benefits to the surgeon. Gravity retracts the lung anteriorly, exposing the diaphragmatic hiatus. Single-lumen endotracheal intubation combined with low-pressure carbon dioxide insufflation efficiently collapses the lung to create ample working space. For the two reported patients, only three trocars were necessary to complete suture ligation of the thoracic duct via the right chest. Both patients had complete resolution of their chylothorax and recovered uneventfully. Based on this experience, the authors currently advocate early thoracoscopic treatment for cost and morbidity savings.

Conclusions

The authors believe prone thoracoscopic thoracic duct ligation offers significant advantages to the patient in preventing the dangerous consequences of chyle leak in a timely, minimally invasive fashion. Importantly, the prone technique with carbon dioxide insufflation makes the technical challenges of thoracic duct ligation more facile for the surgeon.

Keywords

Thoracoscopy Thoracic duct Chylothorax Complications Technique 

Supplementary material

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References

  1. Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC (1996) Postoperative chylothorax. J Thorac Cardiovasc Surg 112:1361–1366PubMedCrossRefGoogle Scholar
  2. Merigliano S, Molena D, Ruol A, Zaninotto G, Cagol M, Scappin S, Ancona E (2000) Chylothorax complicating esophagectomy for cancer: a plea for early thoracic duct ligation. J Thorac Cardiovasc Surg 119:453–457PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Peter M. Denk
    • 1
    Email author
  • Prakash Gatta
    • 1
  • Lee L. Swanström
    • 1
  1. 1.Division of Gastrointestinal and Minimally Invasive SurgeryLegacy Health System and The Oregon ClinicPortlandUSA

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