Minimally invasive surgery helps dogs with idiopathic chylothorax

Abstract

OBJECTIVE: To describe a technique and evaluate the outcome of thoracoscopic thoracic duct ligation (TDL) and subphrenic pericardiectomy (SPP) for treatment of idiopathic chylothorax (IC) in dogs. DESIGN: Retrospective case series. ANIMALS: 6 client-owned dogs. PROCEDURES: Medical records of dogs with a diagnosis of IC that were subsequently treated by thoracoscopic TDL and SPP and that had not undergone previous surgical treatment were reviewed. Thoracoscopic TDL was performed via a 3-portal technique with the patient in lateral recumbency. Subphrenic pericardiectomy was subsequently performed via a 3-portal technique with the patient in dorsal recumbency. If visualization during SPP was suboptimal, 1-lung ventilation was used to ensure that pericardial resection was close to the phrenic nerves bilaterally but without risk of iatrogenic nerve injury. RESULTS: All TDL and SPP procedures were completed successfully in a median surgical time of 177 minutes (range, 135 to 210 minutes). All 6 dogs showed resolution of clinical signs of chylothorax with no recurrence during a median follow-up period of 39 months (range, 19 to 60 months). Final postoperative thoracic radiographic evaluation was performed at a median of 14.5 months (range, 7 to 25 months). Complete resolution of pleural effusion occurred in all but 1 dog. In 1 dog, a small volume of pleural effusion was persistent at a 7-month postoperative radiographic follow-up but was not associated with clinical signs and did not require thoracocentesis at any time during the dog's 25-month follow-up period. CONCLUSIONS AND CLINICAL RELEVANCE: From this limited series of patients, results suggested that a minimally invasive TDL-SPP combined surgical technique for management of IC in dogs may be associated with a similarly successful outcome as has been reported for open surgical TDL-SPP.