Thoracoscopic direct clipping of the thoracic duct for chylopericardium and chylothorax.
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.
Wurnig
P N
PN
Department of Surgery, The Christ Hospital, University of Cincinnati, Ohio, USA.
Hollaus
P H
PH
Ohtsuka
T
T
Flege
J B
JB
Wolf
R K
RK
D000293:Adolescent; D000328:Adult; D000368:Aged; D002916:Chylothorax / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000601:surgery*; D013897:Thoracic Duct / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*