Thoracoscopic ligation of the thoracic duct for a massive chylothorax following a thoracolaparoscopic oesophagectomy

Venkateshwara Mahadevan; Karthick Kalaichelvan; Raghunath K. J.; Balachandran Premkumar; Sheena Ali; Subhankar Paul

doi:10.18203/2349-2902.isj20184107

Authors

Venkateshwara Mahadevan Department of General, Gastrointestinal and Bariatric Surgery, Apollo Speciality Hospitals OMR, Chennai, Tamil Nadu, India
Karthick Kalaichelvan Department of General Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
Raghunath K. J. Department of General Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
Balachandran Premkumar Department of General, Gastrointestinal and Bariatric Surgery, Apollo Speciality Hospitals OMR, Chennai, Tamil Nadu, India
Sheena Ali Department of General, Gastrointestinal and Bariatric Surgery, Apollo Speciality Hospitals OMR, Chennai, Tamil Nadu, India
Subhankar Paul Department of General Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India http://orcid.org/0000-0001-7553-0733

DOI:

https://doi.org/10.18203/2349-2902.isj20184107

Keywords:

Carcinoma oesophagus, Chylothorax, Management of thoracic duct chyle leak, Thoraco-laparoscopic-oesophagectomy, Thoracic duct injury

Abstract

Chyle leak is an uncommon yet solemn complication following several head, face and neck surgeries, especially malignancies. Thoracic duct injury usually has an insidious onset and a long course of response and improvement rendering the patient nutritionally debilitated and immunocompromised. Hence, the prompt identification and treatment of a chyle leak is essential for an optimal surgical outcome. Here, we present an interesting case report of a chylothorax, as a postoperative sequela in a 70-year-old male with carcinoma oesophagus who underwent a Thoracolaparoscopic oesophagectomy. He was managed by a thoracoscopic ligation of the thoracic duct, which not only negated the need for a major thoracic procedure, but also provided a good surgical outcome.

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References

Huggins JT. Chylothorax and cholesterol pleural effusion. Semen Respir Crit Care Med. 2010;31:743-50.

Graham DO, McGahren ED. Use of video assisted thoracic surgery in treatment of chylothorax, Ann Thorac Surg. 1994;57:1507-12.

Talwar A, Lee HJ. A contemporary review of chylothorax. Indian J Chest Diss Allied Sci. 2008;50:343-51.

Johsman W. Chylothorax. Brief review of literature: report of 3 non-traumatic cases. Ann Intern Med. 1944;21:669.

Lampson RS. Traumatic chylothorax: a review of literature and report of a case treated by mediastinal ligation of the thoracic duct. J Thorac Surg. 1948;17:778-91.

Kausel HW, Reeve TS, Stain AA. Anatomic and pathological studies of the thoracic duct. J Thorac Surg. 1957;34:631-6.

Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg. 2007;32:362-9.

Delaney SW, Shi H, Shokrani A, Sinha UK. Management of chyle leak after head and neck surgery: review of current treatment strategies. Int J Otolaryngol. 2017;2017.

Lee YS, Nam KH, Chung WY, Chang HS, Park CS, Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci. 2010;25(4):541-5.

de Gier HH, Balm AJ, Bruning PF, Gregor RT, Hilgers FJ. Systematic approach to the treatment of chylous leakage after neck dissection. J Sci Specialties of the Head and Neck. 1996;18(4):347-51.

Roehr CC, Jung A, Proquitté H, Blankenstein O, Hammer H, Lakhoo K, et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive care medicine. 2006;32(5):650-7.

Huang PM Lee YC. A new technique of continuous pleural irrigation with minocycline administration for refractory chylothorax. Thorac Cardioc Surg. 2011;59:436-8 .

Rizzardi G, Loy M, Marulli G, Rea F. Persistent chylothorax in lymphangioleiomyomatosis treated by intrapleural instillation of povidone. Eu J Cardio-Thoracic Surg. 2008;34(1):214-5.

Matsukuma E, Aoki Y, Sakai M, Kawamoto N, Watanabe H, Iwagaki S, et al. Treatment with OK-432 for persistent congenital chylothorax in newborn infants resistant to octreotide. J Pediatr Surg. 2009;44:37-9.

Zabeck H, Muley T, Dienemann H, Hoffmann H. Management of chylothorax in adults: when is surgery indicated? Thorac Cardiovasc Surg. 2011;59:243-6.

Shimizu K, Yoshida J, Nishimura M, Takamochi K, Nakahara R, Nagai K. Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg. 2002;124:499.

Bender B, Murthy V, Chamberlain RS. The changing management of chylothorax in the modern era. Eu J Cardio-Thoracic Surg. 2015;49(1):18-24.

Shah RD, Luketich JD, Schuchert MJ, Christie NA, Pennathur A, Landreneau RJ. Postesophagectomy chylothorax: incidence, risk factors, and outcomes. The Annals of Thoracic Surg. 2012;93(3):897-904.

Boffa DJ, Sands MJ, Rice TW, Murthy SC, Mason DP, Geisinger MA, et al. A critical evaluation of a percutaneous diagnostic and treatment strategy for chylothorax after thoracic surgery. Eur J Cardiothorac Surg. 2008;33:435-39

Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg. 2010;139:584-9.