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Thoracoscopic ligation of the thoracic duct
1Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York 10595, USA. GStringel@pol.net
Insights
Thoracoscopic ligation of the thoracic duct is a safe and effective treatment for persistent chylothorax, offering an alternative to traditional thoracotomy surgery.
Area of Science:
- Cardiothoracic Surgery
- Minimally Invasive Procedures
- Thoracic Surgery
Background:
- Chylothorax, characterized by lymphatic fluid in the pleural space, often requires surgical intervention when nonoperative management fails.
- Traditional surgical treatment for chylothorax involves thoracic duct ligation via thoracotomy.
- Persistent chylothorax can lead to significant morbidity and nutritional deficits.
Observation:
- Two cases of persistent chylothorax are presented: a pediatric patient post-Fontan procedure and an adult trauma patient.
- Both patients failed to respond to conservative nonoperative treatments for chylothorax.
- Thoracoscopic ligation of the thoracic duct was successfully employed in both cases.
Findings:
- The pediatric patient experienced reduced chyle drainage post-thoracoscopy, with residual drainage managed by octreotide.
- The adult patient had complete cessation of chyle drainage immediately following thoracoscopic surgery.
- Both patients demonstrated no recurrence of chylothorax during follow-up periods of two years and six months, respectively.
Implications:
- Thoracoscopic ligation of the thoracic duct is a viable and effective minimally invasive alternative to thoracotomy for treating chylothorax.
- This approach may reduce surgical morbidity associated with open chest procedures.
- Further research into minimally invasive thoracic duct ligation for chylothorax is warranted.
Objective:
When nonoperative treatment of chylothorax fails, thoracic duct ligation is usually performed through a thoracotomy. We describe two cases of persistent chylothorax, in a child and an adult, successfully treated with thoracoscopic ligation of the thoracic duct.
Methods:
A 4-year-old girl developed a right chylothorax following a Fontan procedure. Aggressive nonoperative management failed to eliminate the persistent chyle loss. A 72-year-old insulin-dependent diabetic man was involved in a motor vehicle accident, in which he sustained multiple fractured ribs, a right hemopneumothorax, a right femoral shaft fracture, and a T-11 thoracic vertebral fracture. Subsequently, he developed a right chylothorax, which did not respond to nonoperative management. Both patients were successfully treated with thoracoscopic ligation of the thoracic duct.
Results:
The child had significant decrease of chyle drainage following surgery. Increased drainage that appeared after the introduction of full feedings five days postoperatively was controlled with the somatostatin analog octreotide. The chest tube was removed two weeks after surgery. After two years' follow-up, she has had no recurrence of chylothorax. The adult had no chyle drainage following surgery. He was maintained on a medium-chain triglyceride diet postoperatively for two weeks. The chest tube was removed four days after surgery. After six months' follow-up, he has had no recurrence of chylothorax.
Conclusions:
Thoracoscopic ligation of the thoracic duct provides a safe and effective treatment of chylothorax and may avoid thoracotomy and its associated morbidity.
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