Treatment of postoperative chylothorax through laparoscopic thoracic duct ligation

Our plain-English summary of Treatment of postoperative chylothorax through laparoscopic thoracic duct ligation, by B.C. Vassallo, D. Cavadas, E. Beveraggi, et al (European Journal of Cardio-thoracic Surgery, 2002).

The study

• Authors: B.C. Vassallo, D. Cavadas, E. Beveraggi, E. Sivori
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2002;21(3):556-7
• Type of article: Case report
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report the laparoscopic transhiatal thoracic duct ligation to solve postoperative chylothorax after right total pleurectomy for malignant diffuse mesothelioma.

In plain English

This case report, from the Italian Hospital in Buenos Aires, Argentina, described one 50-year-old woman with worsening breathlessness and fluid around the right lung. The article does not mention asbestos. It states she had never smoked and lived in a hardly industrial area in the south of Argentina. A biopsy taken during video-thoracoscopy showed malignant mesothelioma. On July 26, 2001 she had a total parietal pleurectomy through the right chest. Forty-eight hours later, drainage of about 800 to 1000 cm3 a day turned milky, and a lymph fluid leak (chylothorax) was confirmed. A fat-free diet and then intravenous feeding did not reduce the flow. She developed low blood protein, metabolic acidosis and impaired clotting. After the metabolic disturbance was corrected and her prothrombin (a clotting measure) had recovered to 83%, surgeons tied off the thoracic duct 14 days after the first operation. They used laparoscopic surgery through the abdomen and the diaphragm opening. Her recovery was uneventful. The chest tube came out after 72 hours and she went home on day 7. The authors concluded the approach can be considered safe and fast with low morbidity.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (one patient)
• Who was studied: One 50-year-old woman with progressive dyspnea and right pleural effusion, treated at the Italian Hospital, Buenos Aires, Argentina; her first operation was on July 26, 2001
• Exposure: No asbestos or occupational exposure is reported. The article states only that she had no smoking history and lived in a hardly industrial area with little smog in the south of Argentina.
• Main results:
  • A biopsy taken at video-thoracoscopy, which showed small white nodules on the parietal pleura, showed malignant mesothelioma. A total parietal pleurectomy was then done through a right thoracotomy.
  • Forty-eight hours after the pleurectomy, daily drainage of about 800 to 1000 cm3 became milky with oral intake. Chylothorax was confirmed by a cream intake test and laboratory analysis.
  • A fat-free diet for 5 days, followed by parenteral nutrition for 7 more days, did not reduce the drainage.
  • Ten days after surgery the patient had severe hypoproteinemia, metabolic acidosis and impaired prothrombin time (25%). She was given vitamin K and the metabolic disturbance was corrected.
  • With prothrombin recovered to 83%, 14 days after the first surgery, the thoracic duct was found on the right side of the aorta. It was ligated and clipped through a laparoscopic transhiatal approach.
  • The postoperative course was uneventful. The pleural tube was removed 72 hours after surgery and the patient was discharged on the 7th day.
• The authors' conclusion: The authors concluded that transhiatal laparoscopic thoracic duct ligation for postoperative chylothorax can be considered a safe and fast procedure with low morbidity. They considered it easier to perform and less aggressive than a second transthoracic or laparotomic approach.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma.

Related studies

• Laparoscopic thoracic duct clipping for persistent chylothorax after extrapleural pneumonectomy — N. Tsubokawa, Y. Hamai, et al. (2012)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series — D.C. Mares, P.N. Mathur (1998)
• A recurrence of benign multicystic peritoneal mesothelioma treated through laparoscopic excision: a case report and review of the literature — T.D. Witek, J.W. Marchese, et al. (2014)
• Postoperative Complications Independently Predict Cancer-Related Survival in Peritoneal Malignancies — M.H.A. Choudry, Y. Shuai, et al. (2018)
• Postoperative morbidity and mortality after pneumonectomy: a 30-year experience of 2064 consecutive patients — C. Pricopi, P. Mordant, et al. (2015)

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