NOTES Thoracic Surgery in a Human Cadaveric Model: Transesophageal Exploration of the Mediastinal, Pericardial and Pleural Spaces Followed By Pleural Biopsy, Lymph Node Sampling, Thoracic Duct Ligation, Vagotomy, Thymectomy and Pericardial Window

Chyle leakage from the neck, which usually occurs after iatrogenic injury of the thoracic or lymphatic duct, is an uncommon complication of head and neck surgeries, which include neck dissection or thyroidectomy. A small amount of chyle leakage can be treated with conservative approaches, such as nutritional limitation, somatostatin analogues, and wound compression. However, massive or uncontrolled chyle leakage requires surgical exploration of the wound and thoracic duct ligation via the chest or transabdominal thoracic duct embolization can be applied. Here, we report a case of intractable massive chyle leakage in a 78-year-old male after a left neck level V lymph node biopsy, which was not controlled after conservative management and explorative surgery. Various treatment approaches were attempted and successful management of chyle leakage was ultimately achieved by thoracic duct embolization.

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A Case of Chylothorax after Esophagectomy for Esophageal Cancer Performed Thoracoscopic Thoracic Duct Ligation in which Lymphangiography by Inguinal Lymph Node Puncture was Usuful

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.77.322 ◽

2016 ◽

Vol 77 (2) ◽

pp. 322-327

Author(s):

Keita HANADA ◽

Hiroaki HATA ◽

Tetsushi OTANI ◽

Masato NARITA ◽

Takashi YAMAGUCHI ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Thoracic Duct ◽

Inguinal Lymph Node ◽

Thoracic Duct Ligation ◽

Duct Ligation

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Bilateral thoracic duct ligation for persisting postoperative chylothorax

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa128 ◽

2020 ◽

Vol 31 (4) ◽

pp. 583-584

Author(s):

Benoît Rouiller ◽

Jon A Lutz ◽

Gregor J Kocher ◽

Lennart Magnusson

Keyword(s):

Computed Tomography ◽

Thoracic Surgery ◽

Thoracic Duct ◽

Anatomical Variation ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Thoracic Duct Ligation ◽

Duct Ligation

Abstract Herein, we report the case of a patient with persistent postoperative chylothorax despite right supradiaphragmal ligation of the thoracic duct. Computed tomography lymphangiography after lipiodol injection demonstrated a correctly ligated right thoracic duct but an anatomical variation with patent left-sided thoracic duct, which was successfully ligated afterwards by video-assisted thoracic surgery.

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Visualisation of the thoracic duct after popliteal lymph node injection in the pig: comparison of radiographic and thoracoscopic techniques

Veterinární Medicína ◽

10.17221/7571-vetmed ◽

2014 ◽

Vol 59 (No. 6) ◽

pp. 276-282

Author(s):

D. Vnuk ◽

A. Gudan Kurilj ◽

D. Maticic ◽

G. Dupre

Keyword(s):

Methylene Blue ◽

Lymph Node ◽

Thoracic Duct ◽

Popliteal Lymph Node ◽

Lymph Vessel ◽

Total Occlusion ◽

Thoracic Duct Ligation ◽

Duct Ligation ◽

Radiographic Contrast ◽

The Right

Radiographic contrast studies have been recommended to identify the thoracic duct (TD) and its branches before and after surgery for total occlusion. The macroscopic identification of the TD and its branches during surgery usually involves injection of methylene blue (MB). Radiographic contrast and methylene blue can be injected into different anatomical structures (lymph node, lymph vessel, s.c.). The purpose of this study was to compare two different techniques (radiographic and thoracoscopic) for visualisation of the TD after intrapopliteal lymph node injection in the pig. Six piglets from the same litter (two males and four females), two months of age were used. Iohexol at 245 mg/ml was injected into the left popliteal lymph node (LN) under general anaesthesia; hindlimb, abdominal, and thoracic radiographs were taken. A 0.25% methylene blue solution was injected into the right popliteal lymph node and the thoracic duct colouration was assessed thoracoscopically. The thoracic duct was visualised radiographically in one out of six pigs after iohexol injection and thoracoscopically in five out of six pigs after methylene blue injection. The difference was statistically significant (P = 0.040). Popliteal LN lymphangiography using iohexol at 245 mg/ml in piglets should not be the recommended method for TD visualisation. Intrapopliteal injection of a 0.25% solution of methylene blue is recommended as a method of TD visualisation prior to thoracic duct ligation.  

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Thoracic duct injury after decortication of lung, new technique to repair thoracic duct in this challenging situation: A case report

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492321997080 ◽

2021 ◽

pp. 021849232199708

Author(s):

Nandkishore Kapadia ◽

Saumya Sekhar Jenasamant ◽

Ganesh Sohan Singh Rawat ◽

Shailesh Kamkhedkar ◽

Pratik Shah ◽

...

Keyword(s):

Thoracic Duct ◽

Left Lung ◽

Lower Lobe ◽

Late Complications ◽

Patch Repair ◽

Double Lumen Tube ◽

Complex Case ◽

Thoracic Duct Injury ◽

Thoracic Duct Ligation ◽

Duct Ligation

Background Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Very few patients respond to conservative line of therapy. Thoracic duct ligation is often the treatment of choice in post-surgical patients; however, the optimal treatment of this disease process after traumatic injury remains unclear. Case presentation: We present the case of a 46-year-old woman with thoracic duct injury secondary to decortication for post-pneumonic empyema. Conservative therapy and pleurodesis done twice failed. She developed severe cachexia losing 15 kg in 30 days. She was referred to our center for ligation of thoracic duct. Preoperative lymphangiography located the duct injury in upper part of mediastinum. Computerized tomography scan of chest showed collapse of left lower lobe and thickened left pleura, indicating a significant pericardial effusion. She underwent decortication of left lung, pericardial window, and native pericardial patch repair of thoracic duct. Results and Conclusions: In this unusual and complex case, successful resolution of the chyle leak was achieved with new surgical technique of patch repair. The patient recovered well and was now on a normal diet. She has put on 12 kg in four months. We have avoided late complications of thoracic duct ligation by this technique. This nouvelle technique may be recommended as it is simple and effective. Ligation of thoracic duct carries late complications. Isolating right lung by double lumen tube may cause severe hypoxia as left-sided lung is not expanded as in this case.

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665 PROPHYLACTIC THORACIC DUCT OBSTRUCTION DURING ESOPHAGECTOMY: THE IMPACT ON PERIOPERATIVE RISKS AND LONG-TERM SURVIVAL. A SYSTEMATIC REVIEW AND META-ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doab052.665 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Clara Santos ◽

Laura Santos ◽

Leticia Datrino ◽

Guilherme Tavares ◽

Luca Tristão ◽

...

Keyword(s):

Systematic Review ◽

Overall Survival ◽

Postoperative Complications ◽

Thoracic Duct ◽

Meta Analysis ◽

Term Survival ◽

Long Term Survival ◽

Thoracic Duct Ligation ◽

Duct Ligation

Abstract During esophagectomy for cancer, there is no consensus if prophylactic thoracic duct ligation (TDL), with or without thoracic duct resection (TDR), could influence the perioperative outcomes and long-term survival. This systematic review and meta-analysis compared patients who went through esophagectomy associated or not to ligation or resection of the thoracic duct. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central and Lilacs (BVS). The inclusion criteria were: (1) studies that compare thoracic duct ligation, with or without resection, and non-thoracic duct ligation; (2) involve adult patients with esophageal cancer; (3) articles that analyses the outcomes—perioperative complications, perioperative mortality, chylothorax development and overall survival; (4) only clinical trials and cohort were accepted. A 95% confidence interval (CI) was used, and random-effects model was performed. Results Fifteen articles were selected, comprising 6,249 patients. TDL did not reduce the risk for chylothorax (Risk difference [RD]: -0.01; 95%CI: −0.02, 0.00). Also, TDL did not influence the risk for complications (RD: -0.02; 95%CI: −0.11, 0.07); mortality (RD: 0.00; 95%CI: −0.00, 0.00); and reoperation rate (RD: -0.01; 95%CI: −0.02, 0.00). TDR was associated with higher risk for postoperative complications (RD: 0.1; 95%CI 0.00, 0.19); chylothorax (RD: 0.02; 95%CI 0.00, 0.03). Both TDL and TDR did not influence the overall survival rate (TDL: HR: 1.17; 95%CI: 0.86, 1.48; and TDR: HR: 1.16; 95%CI: 0.8, 1.51). Conclusion Thoracic duct obliteration with or without its resection during esophagectomy does not change long term survival. Nonetheless, TDR increased the risk for postoperative complications and chylothorax.

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Robotic Transthoracic Thoracic Duct Ligation

Atlas of Robotic Thoracic Surgery ◽

10.1007/978-3-319-64508-7_20 ◽

2018 ◽

pp. 181-189

Author(s):

Kemp Kernstine ◽

John K. Waters

Keyword(s):

Thoracic Duct ◽

Thoracic Duct Ligation ◽

Duct Ligation

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Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200272 ◽

2020 ◽

Vol 8 (2) ◽

pp. 767

Author(s):

Oluwaseun R. Akanbi ◽

Swaminathan Vaidyanathan ◽

Prakash Agarwal ◽

Janeel Musthafa ◽

Neville A. G. Solomon

Keyword(s):

Thoracic Duct ◽

Medium Chain Triglyceride ◽

Cystic Lymphangioma ◽

Satisfactory Outcome ◽

Thoracic Duct Ligation ◽

Risk Of Mortality ◽

Duct Ligation ◽

Surgical Options ◽

Polytetrafluoroethylene Patch ◽

Substantial Morbidity

Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first employed in managing this. Surgical options are adopted when the effusion is protracted, most recent of which includes diaphragmatic fenestration. A 9-year-old girl is presented who developed recurrent right chylothorax following thoracoscopic excision of a cystic lymphangioma. Following failed conservative therapy, she had thoracic duct ligation and right diaphragmatic fenestration (using fenestrated polytetrafluoroethylene patch) with satisfactory outcome. Aetio-pathologic mechanisms implicated in postoperative chylothorax have been classified into traumatic (iatrogenic injury to the thoracic duct or its branches) and non-traumatic. With initial conservative measures (repeated pleural aspirations and intercostal drainage, medium chain triglyceride/ low fat feeds or alternatively, fasting and total parenteral nutrition) spontaneous closure remains unpredictable. Diaphragmatic fenestration when employed resulted in faster resolution of effusion and earlier commencement of enteral feeding with no significant complication. Diaphragmatic fenestration is effective and safe for treating refractory post-operative chylothorax.

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