Transabdominal ligation of the thoracic duct as treatment of choice for postoperative chylothorax after esophagectomy

Abstract

Postoperative chylothorax after injury of the thoracic duct during esophagectomy is a rare but severe complication which may lead to serious problems such as loss of fat and proteins, and immunodeficiency. Without treatment mortality can rise to over 50%. From 1988 to 2005, we treated 10 patients with postoperative chylothorax after 409 resections of the esophagus (2.4%). Of these 10 patients nine underwent transthoracic esophagectomy with gastric pull-up to enable an intrathoracic (n = 7) or cervical (n = 2) anastomosis and one patient received a transhiatal esophagectomy with gastric pull-up and cervical anastomosis. The average amount of postoperative chylus was 2205 mL (200-4500 mL) per day. After a median postoperative interval of 10 days, relaparotomy and transhiatal double ligation of the thoracic duct was performed in nine out of 10 patients. One patient could be managed conservatively. The average amount of chylus was reduced to 151 mL per day (90.5%). Seven patients had no complications, and three suffered from postoperative pneumonia. Two of the patients with pneumonia recovered, and one died. Discharge from hospital, after ligation of the thoracic duct, was possible after a median time of 18 days (11-52). Ligation of the thoracic duct via relaparotomy appeared to be a simple and safe method to treat postoperative chylothorax.

Comparison of Early and Late Complications in Three Esophagectomy Techniques

“…If chyle is not stopped, patients will faced immune deficiency, resulting in infection and mortality (35). Some studies have shown the superiority of surgery over conservative treatment (34,(38)(39)(40). Thus, the treatment method of Chylothorax is conservative but when the outlet of the chest tube is more than 800 cc per day and it will continue for 4 to 5 consecutive days, waiting for stopping the leak may be dangerous due to leukopenia and malnutrition; therefore, surgery is required in these circumstances.…”

Chylothorax after esophagectomy for esophageal cancer: Risk factors and management

“…The reported incidence of chylothorax in transhiatal esophagectomy ranges from 0.6 % to 10.5 % [1][2][3]. Due to this low incidence, there is very few evidence on its predisposing factors and its optimal treatment of choice.…”

Pleural Fluid Characteristics of Chylothorax

“…[4][5][6][7] Chylous pleural effusions are typically described as exudative lymphocytic pleural effusions with a milky appearance. However, biochemical parameters of chylous pleural effusions have been inadequately analyzed.…”