Treatment of postoperative chylothorax through laparoscopic thoracic duct ligation

Vassallo, B C; Cavadas, Demetrio; Beveraggi, Enrique; Sivori, Enrique

doi:10.1016/s1010-7940(01)01137-x

Cited by 18 publications

(10 citation statements)

References 5 publications

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“…No identification of the exact site of injury of the thoracic duct is necessary. The abdominal approach by laparotomy 10,16 or laparoscopically in case reports after lung resection or pleurectomy 38,39 has been reported only occasionally. To minimize the overall risk of postoperative chylothorax, a preventive ligation performed through the hiatus or transthoracic is recommended in some reports.…”

Section: Discussionmentioning

confidence: 99%

Transabdominal ligation of the thoracic duct as treatment of choice for postoperative chylothorax after esophagectomy

Schumacher

Weidemann

Langrehr

et al. 2007

Diseases of the Esophagus

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Postoperative chylothorax after injury of the thoracic duct during esophagectomy is a rare but severe complication which may lead to serious problems such as loss of fat and proteins, and immunodeficiency. Without treatment mortality can rise to over 50%. From 1988 to 2005, we treated 10 patients with postoperative chylothorax after 409 resections of the esophagus (2.4%). Of these 10 patients nine underwent transthoracic esophagectomy with gastric pull-up to enable an intrathoracic (n = 7) or cervical (n = 2) anastomosis and one patient received a transhiatal esophagectomy with gastric pull-up and cervical anastomosis. The average amount of postoperative chylus was 2205 mL (200-4500 mL) per day. After a median postoperative interval of 10 days, relaparotomy and transhiatal double ligation of the thoracic duct was performed in nine out of 10 patients. One patient could be managed conservatively. The average amount of chylus was reduced to 151 mL per day (90.5%). Seven patients had no complications, and three suffered from postoperative pneumonia. Two of the patients with pneumonia recovered, and one died. Discharge from hospital, after ligation of the thoracic duct, was possible after a median time of 18 days (11-52). Ligation of the thoracic duct via relaparotomy appeared to be a simple and safe method to treat postoperative chylothorax.

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Section: Discussionmentioning

confidence: 99%

Transabdominal ligation of the thoracic duct as treatment of choice for postoperative chylothorax after esophagectomy

Schumacher

Weidemann

Langrehr

et al. 2007

Diseases of the Esophagus

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“…The recent abdominal surgery and the debilitated physical condition precluded a thoracotomy approach as well as laparoscopic closure of the thoracic duct in our patients. 7 VATS has became the preferred surgical method to deal with this complication because of its easy manageability and low morbidity. 8 It was performed under local anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax after abdominal surgery

Griffo

Luca

Stassano

2010

Gen Thorac Cardiovasc Surg

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Chylothorax is usually a complication of thoracic surgery procedures. Over a 5-year period we encountered three cases of chylothorax following abdominal surgery performed in general surgery units. The initial effusions, not lactescent, were ascribed to a pleural reaction that sometimes is observed during the postoperative period after abdominal surgery. Once the diagnosis was established, the initial conservative treatment failed, and surgery was necessary. In our patients, their debilitated physical condition precluded a thoracotomy approach. A video-assisted thoracoscopy procedure was undertaken, but the extensive pleural effusions, caused in part by the delay in the diagnosis, prevented the exact localization of the duct and its closure. Talc pleurodesis was successfully employed in all patients. Even after abdominal surgery, a persistent pleural effusion should always induce us to suspect a chylothorax.

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“…(2,12,(19)(20)(21) Mesmo quando não se encontre o ducto torácico em sua posição habitual, a ligadura em massa é efetiva em 80% dos casos.…”

Section: Tratamentounclassified

“…Nestes casos as ligaduras do ducto torácico podem ser realizadas através de fios, clipagem ou mesmo com grampeadores, com resultados excelentes. (19)(20)(21) Após o tratamento cirúrgico espera-se que haja uma rápida redução no débito dos drenos torácicos. Assim como comentado anteriormente para o tratamento conservador, administra-se uma refeição hipergordurosa antes da remoção do dreno.…”

Section: Tratamentounclassified

Quilotórax

Vaz

Fernandes

2006

J. bras. pneumol.

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INTRODUÇÃOO quilotórax é definido como acúmulo de linfa no espaço pleural. É uma causa pouco freqüente, mas importante de derrame pleural, com diagnós-tico usualmente difícil. O termo quilo refere-se à aparência leitosa da linfa, devida ao seu conteúdo rico em gordura. (1) O quilotórax resulta tanto da obstrução, ou dificuldade de escoamento do quilo, quanto da laceração do ducto torácico, sendo suas causas mais comuns as neoplasias, trauma, causas congênitas, infecções e trombose venosa do sistema da veia cava superior. Sua incidência tem sido da ordem de 0,25% a 0,5% nos casos de cirurgia torácica. (1) O reconhecimento precoce e a terapia adequada da fístula do ducto torácico previnem a depleção nutricional e linfocitária secundária. (2) A compreensão de sua fisiopatologia, diagnóstico e tratamento reduziram a mortalidade inicial de 50% para 10% na maioria dos centros médicos. (1) ANATOMIA DO DUCTO TORÁCICOEm seu padrão mais freqüente, o ducto torácico origina-se na cisterna do quilo, estrutura abdominal que drena os vasos linfáticos das extremidades inferiores, pelve e intestino, sendo a principal via de escoamento da gordura alimentar absorvida nos intestinos. O ducto torácico penetra no tórax através do hiato aórtico em direção ao lado direito, em posição retro-aórtica, situando-se entre a veia ázi-gos e a aorta, na porção inferior do tórax, logo atrás do esôfago. Ascende pelo mediastino posterior, cruzando lateralmente para o lado esquerdo no nível de T4, correndo atrás do arco aórtico, do lado esquerdo do esôfago, e mais superiormente, atrás da artéria subclávia esquerda. Após sua entrada no pescoço, ele curva-se anteriormente, na borda do músculo escaleno anterior, e anastomosase na junção das veias jugular interna e subclávia esquerdas. Ao longo deste trajeto, existe uma rede Capítulo 6RESUMO O quilotórax, normalmente secundário a doenças malignas, trauma, doenças congênitas, infecções e trombose da veia cava superior, é uma causa pouco freqüente de derrame pleural. O diagnóstico e tratamento precoces são importantes no sentido de prevenir a mais temida conseqüência do quilotórax, a má nutrição e conseqüente comprometimento do estado imunológico.Descritores: Derrame pleural/complicações; Quilotórax/etiologia; Quilotórax/diagnostico; Quilotórax/cirurgia ABSTRACT Chylothorax, an uncommon cause of pleural effusion, is usually secondary to malignancy, trauma, congenital diseases, infections and superior vena cava thrombosis. The early diagnosis and treatment are important to prevent the most fearful consequence of chylothorax, the malnutrition with a compromised immunological status.

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Treatment of postoperative chylothorax through laparoscopic thoracic duct ligation

Abstract: We report the laparoscopic transhiatal thoracic duct ligation to solve postoperative chylothorax after right total pleurectomy for malignant diffuse mesothelioma.

Cited by 18 publications

References 5 publications

Transabdominal ligation of the thoracic duct as treatment of choice for postoperative chylothorax after esophagectomy

Transabdominal ligation of the thoracic duct as treatment of choice for postoperative chylothorax after esophagectomy

Chylothorax after abdominal surgery

Quilotórax

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