Laparoscopic ligation of cisterna chyli for refractory chylothorax: A case series and review of the literature

Abstract

Laparoscopic ligation of cisterna chyli is an available therapeutic option for patients with chylothorax unresponsive to medical management, embolization, and transthoracic ligation of the thoracic duct. Our series is comparable with other reports of transabdominal approach to chylothorax.

Refractory chylous effusions in lymphangioleiomyomatosis patient post lung transplant

“…14 A successful transabdominal approach to the cisterna chyli has been described in LAM after lung transplantation. 15 In a recent study, management by thoracic duct embolization has proven efficacious in treating chylous effusions with a 62% success rate. 16 For chylothorax, thoracoscopy or thoracotomy with lung decortication, and thoracic duct ligation with or without mechanical pleurodesis is an alternative method and may be more effective than thoracic duct embolization.…”

Prävention und operative Therapie des Chylothorax

“…In einer randomisierten Studie an 52 Patienten mit persistierendem Chylothorax nach transhiataler Ösophagusresektion und konservativem Therapieversuch zeigte sich dieses Verfahren sogar effektiver als die Ligatur des Ductus thoracicus [23]. Weitere (Reserve-) Verfahren sind die Anlage eines pleuroperitonealen Shunts [24,25] oder bei Versagen der transabdominellen oder transthorakalen Ligatur die (laparoskopische) Ligatur der Cysterna chylei [26].…”

Thinking outside the duct

“…In this issue of the Journal, Diaz-Gutierrez and colleagues 9 describe a minimally invasive, laparoscopic transabdominal approach for ligating the cisterna chyli that they used in 3 patients who had persistent chylothoraces after traditional interventions. They approached the cisterna chyli by exposing the lateral aorta at the celiac trunk, dissecting the inferior vena cava away from the right crus and bringing up the cisterna chyli from behind.…”