Thoracic duct injury following esophagectomy in carcinoma of the esophagus: ligation by the abdominal approach.
BACKGROUND
Thoracic duct injury (TDI) is a potentially lethal complication of esophagectomy. There is no consensus regarding when and how to intervene in these injuries. Both thoracic and abdominal approaches have been used.


METHODS
Esophagectomies performed for cancer of the esophagus (n = 104) from October 2003 to July 2011 were analyzed for TDI. Diagnosis, histological type, stage, and location of tumor, neoadjuvant therapy, trans-thoracic or trans-hiatal procedure performed, nature and amount of drain output, and levels of triglyceride in the effluent were analyzed. Management of these injuries and morbidity and mortality associated with the approach taken were reviewed.


RESULTS
We observed chylothorax in 9 patients. All nine patients had undergone trans-hiatal esophagectomy. All patients eventually required surgical intervention. Mass ligation of the thoracic duct was performed via the thoracic route in three patients and via the trans-abdominal approach in six others. Thoracic duct ligation was successful in all patients. One patient required a second laparotomy and repeat ligation of the duct. There were two postoperative deaths; both these patients had ligation by the thoracic route.


CONCLUSIONS
Trans-abdominal ligation of the thoracic duct in patients with chylothorax after esophagectomy is technically easy and safe. It may be preferred over the trans-thoracic approach, especially after an initial trans-hiatal esophagectomy.
Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and Maulana Azad Medical College, Second floor, Academic Block, 1, Jawaharlal Nehru Marg, New Delhi 110002, India.
Pramod Kumar
PK
Mishra
Sundeep Singh
SS
Saluja
Dinesh
D
Ramaswamy
Satinderpal Singh
SS
Bains
Parvez David
PD
Haque
D000005:Abdomen; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013897:Thoracic Duct / Q000293:injuries* / Q000601:surgery*