Single paracostal approach to thoracic duct and cisterna chyli: experimental study and case series

Vet Surg. 2011 Oct;40(7):786-94. doi: 10.1111/j.1532-950X.2011.00878.x. Epub 2011 Sep 14.

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.

Publication types

  • Clinical Trial

MeSH terms

  • Animals
  • Chylothorax / surgery
  • Chylothorax / veterinary*
  • Dog Diseases / surgery*
  • Dogs
  • Female
  • Thoracic Duct / anatomy & histology
  • Thoracic Duct / surgery*
  • Thoracic Surgical Procedures / methods
  • Thoracic Surgical Procedures / veterinary*