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Ann Thorac Surg 2000;70:1662-1665
© 2000 The Society of Thoracic Surgeons

Original articles: general thoracic

Thoracoscopic direct clipping of the thoracic duct for chylopericardium and chylothorax

Peter N. Wurnig, MDa, Peter H. Hollaus, MDa, Toshiya Ohtsuka, MDa, John B. Flege, MDa, Randall K. Wolf, MDa

a Department of Surgery, The Christ Hospital, University of Cincinnati, Cincinnati, Ohio, USA

Address reprint requests to Dr Wolf, Division of Cardiothoracic Surgery, The Ohio State University Medical Center, N816 Doan Hall, 410 W 10th Ave, Columbus, OH 43210
e-mail: wolf-4{at}medctr.osu.edu

Background. Chylothorax is a challenging clinical problem. Untreated, it carries a high mortality and morbidity. Traditional surgical management for cases refractory to conservative treatment is thoracic duct ligation through a right open thoracotomy.

Methods. We describe 4 patients treated successfully by video-assisted thoracic surgery, using ports and no thoracotomy, and precise ligation and division of the thoracic duct just above the diaphragm. A pericardial window was made in the patient with chylopericardium, as in the patient with end-stage renal disease. Pleurodesis was used in the patient with esophageal carcinoma and the patient with jugular and subclavian vein thrombosis.

Results. There were 2 women aged 18 and 42 years and 2 men, aged 61 and 65 years. No procedure-related mortality or morbidity occurred. In patients 1, 2, 3, and 4, the postoperative duration of drainage was 5, 7, 7, and 5 days, respectively (mean duration, 6 days) and the hospital stay, 5, 9, 10, and 5 days, respectively (mean stay, 7 days). There was no recurrence of chylothorax or chylopericardium during follow-up (range, 2 to 24 months; mean follow-up, 9 months). One patient died of esophageal carcinoma 4 months after operation.

Conclusions. Video-assisted thoracic surgery without a thoracotomy is an effective way of treating chylothorax and carries minimal morbidity.




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