Thoracoscopic Thoracic Duct Ligation and Thoracoscopic Pericardectomy for Treatment of Chylothorax in Dogs

Abstract

Thoracoscopy for ligation of the thoracic duct and pericardectomy is an acceptable surgical technique for treatment of chylothorax.

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

“…Thoracoscopic visualisation of the TD has been documented in dogs (Radlinsky et al 2002;Allman et al 2010;Leasure et al 2011) and in pigs (Ashitate et al 2011). Positioning the patient in sternal recumbency allows better access to the caudal mediastinal structures and to the tissues located from the dorsal to the aorta.…”

“…In the dog, MB injection resulted in a positive thoracic duct visualisation in 10/10 patients after intramesenterial LN injection versus 6/10 after intra-popliteal visualisation (Enwiller et al 2003). Thoracic duct colouration via popliteal LN injection (MB) failed in one dog (1/3) (Allman et al 2010). Leasure et al (2011) cannulated an efferent mesenteric lymphatic vessel in the region of the ileocecocolic LNs in dogs; after MB injection, the TD colouration was successful in all dogs (5/5).…”

“…These results suggest that the success rate of popliteal lymphangiography in dogs is higher than in pigs. Allman et al (2010) injected meglumine diatrizoate into a mesenteric lymphatic vessel and obtained a positive TD lymphangiographic study in only one out of three dogs, whereas Leasure et al (20111) visualised the TD in six out of six dogs after injection of meglumine and sodium diatrizoate into a mesenteric lymphatic vessel. Tsuruno et al (2009) injected iohexol into the testicles of rabbits.…”

“…This X-ray confirms the adequate intra-popliteal injection of the contrast medium (arrow) and the slow proximal diffusion of contrast media to the iliosacral lymph centre (arrowhead) Nevertheless, in our study, the success rate of TD visualisation after MB injection was higher than in Enwiller's study on dogs. Since Allman et al (2010) were unsuccessful in their attempts to inject MB percutaneously into the popliteal LN in dogs, we opted for the dissection and direct visualisation of LN in our study. The dissection of the popliteal region was a simple procedure and did not require the usage of magnification.…”

“…Because the observed resolution rates with conservative management are low, surgery is usually preferred. Current surgical management of chylothorax consists of the following: TD ligation (Fossum et al 1986;Fossum et al 1991); partial pericardiectomy with or without TD ligation (Fossum et al 2004;Carobbi et al 2008); clipping of the TD during thoracoscopy (Radlinsky et al 2002); clipping or sealing of the TD and pericardiectomy during thoracoscopy (Allman et al 2010;Haimel et al 2012); cisterna chyli ablation with or without TD ligation (Hayashi et al 2005;Sakals et al 2011); omentalisation with or without TD ligation (Williams and Niles 1999;Talavera et al 2009;Stewart and Padgett 2010); or pleurodesis (Radlinsky 2012).…”