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

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Abstract

Objectives: We describe an alternative surgical technique for the treatment of chylothorax in patients who have had failure of or are not candidates for transthoracic ligation or embolization by interventional radiology. Methods: We describe our experience with laparoscopic ligation of the cisterna chyli in 3 such patients and compare our results with published literature. We used a 5-port approach as for foregut surgery. We retracted the liver, transected the gastrohepatic ligament, and retracted the stomach to the left. We exposed the right lateral aspect of the aorta at the level of the celiac trunk and clipped fatty tissue between the aorta and the right crus. We skeletonized the right crus and dissected from the right crus to the inferior vena cava. We then retracted the inferior vena cava laterally, exposed all soft tissue posteriorly, and identified the cisterna chyli posteromedially to the inferior vena cava. Finally, we ligated and clipped all fatty tissue between the right crus and the inferior vena cava. Results: Success rate was 67%; 1 patient with idiopathic chylothorax did not have resolution and eventually died of multisystem organ failure. There were no procedure-related complications. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)815-819
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume155
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Chylothorax
Thoracic Duct
Inferior Vena Cava
Ligation
Aorta
Adipose Tissue
Interventional Radiology
Ligaments
Abdomen
Stomach
Liver
Therapeutics

Keywords

  • MeSH
  • chylothorax
  • laparoscopy
  • ligation
  • thoracic duct

PubMed: MeSH publication types

  • Case Reports
  • Journal Article
  • Review
  • Webcast

Cite this

@article{7cb9c6480b7140cd871f38c3252e585b,
title = "Laparoscopic ligation of cisterna chyli for refractory chylothorax: A case series and review of the literature",
abstract = "Objectives: We describe an alternative surgical technique for the treatment of chylothorax in patients who have had failure of or are not candidates for transthoracic ligation or embolization by interventional radiology. Methods: We describe our experience with laparoscopic ligation of the cisterna chyli in 3 such patients and compare our results with published literature. We used a 5-port approach as for foregut surgery. We retracted the liver, transected the gastrohepatic ligament, and retracted the stomach to the left. We exposed the right lateral aspect of the aorta at the level of the celiac trunk and clipped fatty tissue between the aorta and the right crus. We skeletonized the right crus and dissected from the right crus to the inferior vena cava. We then retracted the inferior vena cava laterally, exposed all soft tissue posteriorly, and identified the cisterna chyli posteromedially to the inferior vena cava. Finally, we ligated and clipped all fatty tissue between the right crus and the inferior vena cava. Results: Success rate was 67{\%}; 1 patient with idiopathic chylothorax did not have resolution and eventually died of multisystem organ failure. There were no procedure-related complications. Conclusions: 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.",
keywords = "MeSH, chylothorax, laparoscopy, ligation, thoracic duct",
author = "{Diaz Gutierrez}, Ilitch and Rao, {Madhuri V} and Andrade, {Rafael S}",
year = "2018",
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doi = "10.1016/j.jtcvs.2017.08.140",
language = "English (US)",
volume = "155",
pages = "815--819",
journal = "Journal of Thoracic and Cardiovascular Surgery",
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TY - JOUR

T1 - Laparoscopic ligation of cisterna chyli for refractory chylothorax

T2 - A case series and review of the literature

AU - Diaz Gutierrez, Ilitch

AU - Rao, Madhuri V

AU - Andrade, Rafael S

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objectives: We describe an alternative surgical technique for the treatment of chylothorax in patients who have had failure of or are not candidates for transthoracic ligation or embolization by interventional radiology. Methods: We describe our experience with laparoscopic ligation of the cisterna chyli in 3 such patients and compare our results with published literature. We used a 5-port approach as for foregut surgery. We retracted the liver, transected the gastrohepatic ligament, and retracted the stomach to the left. We exposed the right lateral aspect of the aorta at the level of the celiac trunk and clipped fatty tissue between the aorta and the right crus. We skeletonized the right crus and dissected from the right crus to the inferior vena cava. We then retracted the inferior vena cava laterally, exposed all soft tissue posteriorly, and identified the cisterna chyli posteromedially to the inferior vena cava. Finally, we ligated and clipped all fatty tissue between the right crus and the inferior vena cava. Results: Success rate was 67%; 1 patient with idiopathic chylothorax did not have resolution and eventually died of multisystem organ failure. There were no procedure-related complications. Conclusions: 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.

AB - Objectives: We describe an alternative surgical technique for the treatment of chylothorax in patients who have had failure of or are not candidates for transthoracic ligation or embolization by interventional radiology. Methods: We describe our experience with laparoscopic ligation of the cisterna chyli in 3 such patients and compare our results with published literature. We used a 5-port approach as for foregut surgery. We retracted the liver, transected the gastrohepatic ligament, and retracted the stomach to the left. We exposed the right lateral aspect of the aorta at the level of the celiac trunk and clipped fatty tissue between the aorta and the right crus. We skeletonized the right crus and dissected from the right crus to the inferior vena cava. We then retracted the inferior vena cava laterally, exposed all soft tissue posteriorly, and identified the cisterna chyli posteromedially to the inferior vena cava. Finally, we ligated and clipped all fatty tissue between the right crus and the inferior vena cava. Results: Success rate was 67%; 1 patient with idiopathic chylothorax did not have resolution and eventually died of multisystem organ failure. There were no procedure-related complications. Conclusions: 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.

KW - MeSH

KW - chylothorax

KW - laparoscopy

KW - ligation

KW - thoracic duct

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