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. STUDY DESIGN: Observational study and prospective case series. ANIMALS: 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.