Popular guidelines

What is thoracic duct ligation?

What is thoracic duct ligation?

Thoracic duct ligation is the criterion standard. The duct is usually ligated between the eighth and twelfth thoracic vertebrae, just above the aortic hiatus. The approach is usually through the right chest, either by an open right thoracotomy or through a thoracoscope.

What is thoracic duct injury?

Thoracic duct injury is a rare but serious complication following chest surgeries and major neck dissections. Clinically, it can present as cervical chylous fistula, chylothorax or chylopericardium. Without treatment, the mortality is up to 50% and thus, early aggressive therapy is indicated.

How do you check for chyle leak?

To confirm the diagnosis, ascitic or pleural fluid is assayed. The presence of chylomicrons and a triglyceride level higher than 110 mg/dL confirm the diagnosis of a chylous leak. The presence of chyle may be confirmed in the laboratory by measuring fat and protein content, pH, and specific gravity.

Can a surgeon ligate the thoracic duct nonsurgically?

Although this usually can be managed nonsurgically, thoracic surgeons should be adept at surgical ligation of the thoracic duct. The role and anatomy of the thoracic duct can be variable and nebulous, and must be understood to effect surgical management.

How is thoracic duct ligation used to treat chylothorax?

Thoracic duct ligation through thoracotomy is also employedwhen a concurrent thoracic procedure is indicated, such as decortication. Additional techniques described to treat chylothorax include direct ligation of an injured thoracic duct, pleuroperitoneal shunting, and mediastinal radiation. 4, 5

When to use thoracotomy to control chyle leak?

Thoracic duct ligation through thoracotomy is also employedwhen a concurrent thoracic procedure is indicated, such as decortication. The aim of control of the chyle leak is to minimize a protein, lipid, electrolyte, and fluid-losing enteropathy resulting in a malnourished state.

Can a duct leak be ligated via a laparotomy?

If the leak is high in the chest, simple ligation of the main duct at the level of the hiatus via a laparotomy may not be sufficient and the fistulous effusion may continue. The patient may require a third operation. Do not give the cream via the jejunostomy tube too early.

When to use duct ligation in Thoracic Surgery?

The technique of thoracic duct ligation is discussed for two scenarios: Ligation following transthoracic esophagectomy and VATS thoracic duct ligation for spontaneous chylothorax. The approaches and technical steps discussed apply to most indications for duct ligation.

Can a person with chylothorax be ligated?

Spontaneous chylothorax, usually associated with mediastinal diseases such as lymphoma, are not often amenable to such therapy. Both open and thoracoscopic approaches to duct ligation are feasible in most patients.

Are there surgical clips that fail to control the thoracic duct?

Note multiple surgical clips that failed to control the thoracic duct. In most cases of postoperative chylothorax (esophagectomy and lung resection), the patient has already undergone a major operation and presumably appropriate preoperative cardiopulmonary work-up.

Which is not a contraindication for duct ligation?

Increase in chyle output after reinstitution of oral diet or tube feedings. Even severe malnutrition is not a contraindication for the operation, as operation itself is intended to prevent malnutrition and lymphocytopenia. Surgery remains the cornerstone in the management of chylothorax refractory to medical management.