Novel Subdiaphragmatic Ligation of Left Thoracic Duct for Refractory Postoperative Left Chylothorax

A postoperative chylothorax is an uncommon but problematic surgical complication in 0.5% to 4.0% of surgical cases that nevertheless still plagues every busy thoracic surgeon. Fortunately, most chylothoraces are low volume and are readily controlled by conservative measures. A high-volume chylothorax (>1 L/24 h) fortunately occurs in less than one-third of patients, usually responding to the published treatment algorithms and generally requiring invasive techniques. We report a case of a postlobectomy high-volume, left-sided chylothorax refractory to all the usual recommended interventions that ultimately was successfully treated by novel computed tomography lymphangiography-guided transabdominal surgical ligation of the aberrant left-sided lymphatics with complete, prompt chylothorax control.