Chylothorax complicating esophagectomy for cancer: A plea for early thoracic duct ligation

Merigliano, Stefano; Molena, Daniela; Ruol, Alberto; Zaninotto, Giovanni; Cagol, Matteo; Scappin, S.; Ancona, Ermanno

doi:10.1016/s0022-5223(00)70123-1

Cited by 139 publications

(122 citation statements)

References 23 publications

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“…Disruption of these lymphatic pathways can result in both chylothorax as well as chylous ascites. A variety of mechanisms can result in a chyle leak ranging from congenital defects of the lymphatic system to malignancy or trauma [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]. However, chyle leaks are also a recognised complication of abdominal, thoracic and head and neck surgery [1,2,4,5,6,7,8,9,12,13, 15, 18].…”

Section: Introductionmentioning

confidence: 99%

Chyle Leakage and Early Enteral Feeding following Pancreatico-Duodenectomy: Management Options

et al. 2007

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Background: Chyle leaks are a rare complication following abdominal surgery. The aim of this study is to describe the management of chyle leaks following surgery for pancreatico-duodenal malignancy. Methods: Data were collated from a consecutive series of 105 patients who had undergone a pancreatico-duodenectomy for malignancy. From this cohort, patients who developed significant chyle leaks, defined as drainage of more than 600 ml of amylase-poor chylous fluid per day, were identified and their management reviewed. Results: A total of 7 (6.7%) patients with significant chyle leaks were identified. All but one of the chyle leaks were identified between the 5th and 9th post-operative day. Early restoration of enteral feeding appeared to increase the incidence of chyle leak. Six of the 7 patients were successfully treated conservatively with total parenteral nutrition and after a median of 7.5 days the chyle leak had resolved. One patient required a peritoneovenous shunt for chylous ascites. Conclusion: This study has described a high incidence of chyle leak among patients undergoing surgery for pancreatico-duodenal malignancy. Early introduction of enteral feed may encourage development. However, patients who develop an abdominal chyle leak remain clinically well and the leak can be managed relatively easily with parenteral nutrition.

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Section: Introductionmentioning

confidence: 99%

Chyle Leakage and Early Enteral Feeding following Pancreatico-Duodenectomy: Management Options

et al. 2007

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“…The overall incidence of developing a chylothorax after esophagectomy has been reported to range from 2-4% in a high-volume center (6,7). Persistent chyle loss, and its accumulation within the pleural cavity can have serious local, metabolic, and immunological effects which may have a significant impact on postoperative outcome, such as higher instances of pneumonia and arrhythmia, and a longer hospital stay after esophagectomy (8)(9)(10). Currently, chylothorax remains a challenging problem, and no single method for its treatment has been proven to be effective.…”

Section: Discussionmentioning

confidence: 99%

“…Since ligation of the thoracic duct is successful in 90% of patients when performed just above the right hemi-diaphragm (19), a site that has the advantage of halting flow from any unidentified accessory ducts, we routinely perform prophylactic thoracic duct mass ligation at the aforementioned site after dissecting the esophagus. However, although video-assisted prophylactic thoracic duct ligation is an effective approach and can minimize the risk of postoperative chylothorax, the incidence of chylothorax after preventive ligation remains at about 2.7% (8,15). The anatomic variation such as duplicate …”

Section: Discussionmentioning

confidence: 99%

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Localization of thoracic duct using heavily T2W MRI for intractable post-esophagectomy chylothorax—a case report

et al. 2017

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Post-esophagectomy chylothorax is a rare yet serious complication. Herein we report the case of a patient with intractable post-esophagectomy chylothorax despite medical treatment with total parenteral nutrition and octreotide, as well as prophylactic and repeated thoracic duct mass ligation. The patient was eventually treated with localization of thoracic duct using T2-weighted magnetic resonance imaging (T2W MRI), followed by video-assisted thoracoscopic thoracic duct ligation.

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“…Sol taraf eksplore edilmelidir. Eğer kaçak görülmez ise torasik duktusu kontrol edebilmek için toraksa ilk girdiği yer olan sağ taraf yaklaşımı gerekli olabilir (25,26).…”

Section: şIlotoraksunclassified

Surgıcal Complıcatıons In Esophageal Resectıons

Yenigün¹

2016

Toraks Cer Bult

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ÖzetÖzofajektomi operasyonlarını takiben oluşan komplikasyonlar postoperatif mortalite, maliyetleri ve hayatta kalma sonucunu önemli ölçüde etkiler. Pulmoner komplikasyonlar ve anastomoz kaçakları hala en ciddi komplikasyonlar olup erken tanı ve uygun tedavi gereklidir. Özofagus kaçaklarında mortalite oranları, bilgisayarlı tomografi ve endoskopi kullanımının artışı ve sonrasında multidisipliner tedaviler nedeni ile azalmıştır. Anahtar kelimeler: Özofajektomi, kanser, komplikasyon AbstractComplications following esophagectomy significantly affect perioperative mortality, morbidity, survival and costs. Pulmonary complications and anastomotic leaks still remain the most serious complications, and early recognition and appropriate initial treatment are essential. Mortality associated with esophageal leaks is decreasing due, in part, to the increased use of computed tomography (CT) scanning and endoscopy for diagnosis and thus by early application of appropriate multidisciplinary therapy.

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Chylothorax complicating esophagectomy for cancer: A plea for early thoracic duct ligation

Cited by 139 publications

References 23 publications

Chyle Leakage and Early Enteral Feeding following Pancreatico-Duodenectomy: Management Options

Chyle Leakage and Early Enteral Feeding following Pancreatico-Duodenectomy: Management Options

Localization of thoracic duct using heavily T2W MRI for intractable post-esophagectomy chylothorax—a case report

Surgıcal Complıcatıons In Esophageal Resectıons

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