Authors: Peter M Denk Prakash Gatta Lee L Swanström
Publish Date: 2008/09/24
Volume: 22, Issue: 12, Pages: 2742-2742
Abstract
Chylothorax after complex abdominal and thoracic procedures remains a challenging complication with a mortality rate reaching 50 if untreated 1 Iatrogenic trauma accounts for almost 20 of all chyle leaks and esophagectomy is the most common iatrogenic cause 2 Consequences of ongoing chyle leak include dehydration malnutrition and immunocompromiseWhen nonoperative management techniques fail prompt ligation of the thoracic duct at the diaphragmatic hiatus should be attempted The authors present prone thoracoscopic thoracic duct ligation performed for two patients after laparoscopic transthoracic esophagectomy and revision paraesophageal hernia repairThe prone position for thoracoscopic thoracic duct ligation offers several benefits to the surgeon Gravity retracts the lung anteriorly exposing the diaphragmatic hiatus Singlelumen endotracheal intubation combined with lowpressure carbon dioxide insufflation efficiently collapses the lung to create ample working space For the two reported patients only three trocars were necessary to complete suture ligation of the thoracic duct via the right chest Both patients had complete resolution of their chylothorax and recovered uneventfully Based on this experience the authors currently advocate early thoracoscopic treatment for cost and morbidity savingsThe authors believe prone thoracoscopic thoracic duct ligation offers significant advantages to the patient in preventing the dangerous consequences of chyle leak in a timely minimally invasive fashion Importantly the prone technique with carbon dioxide insufflation makes the technical challenges of thoracic duct ligation more facile for the surgeon
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