title: Anastomosis Between Thoracic Duct and Azygos Vein During Esophagectomy: A Novel Technique with 3-year Follow-up.
abstract: Ligation of thoracic duct is the standard procedure currently used to prevent postoperative chylothorax for patients undergoing esophagectomy when thoracic duct is surgically injured or invaded by tumor. However, preservation of lymphovenous circulation is particularly important for a subset of patients, including individuals with liver cirrhosis, ascites, nephrotic syndrome, sclerosing mesenteritis, or some cardiac conditions.
  
  
  
  We have developed a new technique of restoring lymphovenous circulation for patients undergoing esophagectomy. Intrathoracic lymphovenous anastomosis was performed for an esophageal cancer patient by intravenous catheter assisted end-to-side "insertion" technique.
  
  
  
  The time taken for lymphovenous anastomosis was 35 min. No massive bleeding or other adverse events occurred during operation, and the patient had an uneventful postoperative course. Lipid metabolisms, assessed by pre- and postoperative plasma concentrations of cholesterol, triglycerides, high-density and low-density lipoprotein, were not affected after lymphovenous anastomosis. Lymphangiography also indicated lymphovenous anastomosis remained patent 3 years after operation. No long-term surgery-related adverse events were observed during 3-year follow-up.
  
  
  
  Lymphovenous anastomosis was successfully implemented for the patient with esophagectomy, selected patients might benefit from this novel technique.
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
authors.forename: Long-Qi
authors.initials: LQ
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China. doctorzhaoyongfan@hotmail.com.
authors.forename: Yongfan
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D001401:Azygos Vein / Q000601:surgery*; D016063:Blood Loss, Surgical; D002784:Cholesterol / Q000097:blood; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D013897:Thoracic Duct / Q000601:surgery*; D014280:Triglycerides / Q000097:blood
chemical_list: D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; D002784:Cholesterol