Laparoscopic thoracic duct clipping for persistent chylothorax after extrapleural pneumonectomy

Area of Science:

• Thoracic surgery
• Minimally invasive procedures
• Oncology

Background:

• Persistent chylothorax is a rare but serious complication following thoracic surgery, particularly after extrapleural pneumonectomy for malignant pleural mesothelioma.
• Conservative management, including dietary modifications and chest tube drainage, often fails to resolve significant chylothorax.
• Re-operation via a traditional thoracic approach can be challenging and invasive after prior extensive surgery.

Observation:

• A 68-year-old male patient developed persistent chylothorax post-extrapleural pneumonectomy for malignant pleural mesothelioma.
• Initial conservative treatments were unsuccessful in managing the chylothorax.
• A subsequent surgical intervention was necessary.

Findings:

• Laparoscopic thoracic duct clipping was performed as a minimally invasive surgical option.
• The laparoscopic approach successfully identified and clipped the thoracic duct.
• The chylothorax resolved completely following the laparoscopic procedure.

Implications:

• Laparoscopic thoracic duct clipping presents a safe and effective alternative for managing refractory chylothorax after complex thoracic procedures.
• This technique may reduce the morbidity associated with repeat open thoracic surgery.
• It expands the armamentarium for treating postoperative chylothorax in challenging clinical scenarios.