title: Single paracostal approach to thoracic duct and cisterna chyli: experimental study and case series.
abstract: OBJECTIVE
  To-determine the feasibility of a single paracostal abdominal approach for thoracic duct ligation (TDL) and cisterna chyli ablation (CCA) in dogs with chylothorax.
  
  
  METHODS
  Observational study and prospective case series.
  
  
  METHODS
  Normal dogs (n = 5) and dogs with chylothorax (n = 8).
  
  
  METHODS
  A single paracostal approach with transdiaphragmatic extension for TDL and CCA was developed experimentally (n = 5) and used in 8 clinical cases with subtotal pericardectomy (SPE) performed in 4 dogs. Surgery time, complications, hospitalization time, outcome, and follow-up of clinical cases were recorded.
  
  
  RESULTS
  Exposure of relevant anatomy was excellent; vital lymphatic staining facilitated identification of lymphatic structures. In clinical cases, mean surgery time for TDL + CCA was 136 minutes. Mean hospitalization time was 3.1 days. Seven of 8 cases survived, with 1 dog dying of heart failure shortly after discharge. One dog required a second (left) paracostal approach to ligate 2 more lymphatic vessels. On follow-up (median, 7 months; range, 2-20 months), there was complete resolution of chylothorax in 6 dogs.
  
  
  CONCLUSIONS
  A single paracostal approach provides excellent exposure of cisterna chyli, caudal thoracic duct, and intestinal lymphatics. This approach eliminates the need for repositioning during combined TDL + CCA procedures and avoids an intercostal thoracotomy.
authors.affiliation: Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Staiger
authors.forename: Bryden J
authors.initials: BJ
authors.lastname: Stanley
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: McAnulty
mesh_terms: D000818:Animals; D002916:Chylothorax / Q000601:surgery / Q000662:veterinary*; D004283:Dog Diseases / Q000601:surgery*; D004285:Dogs; D005260:Female; D013897:Thoracic Duct / Q000033:anatomy & histology / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000379:methods / Q000662:veterinary*