Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration

    Authors

    K. J. Marthaller; S. P. Johnson; R. M. Pride; E. R. Ratzer;H. W. Hollis

    Comments

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    Abbreviated Journal Title

    Am. J. Surg.

    Keywords

    Chylothorax; Onyx (cyanoacrylates); Coil embolization; Thoracic duct; Thoracic duct disruption; Postesophagectomy chylothorax; MANAGEMENT; CATHETERIZATION; LEAKS; Surgery

    Abstract

    BACKGROUND: Post-esophagectomy patients who develop high-output chylous fistula and chylothorax can be successfully treated with percutaneous ablation thereby avoiding reoperation. METHODS: Five patients with refractory chylous fistula post-esophagectomy were treated with percutaneous embolization. Fistula outputs, evaluation of lymphatic access sites, agents used and additional procedures were analyzed. RESULTS: Successful ablation of the chylous fistula was achieved in 4 of the 5 (80%) patients. Pretreatment chylous output averaged 1,756 mL/day. Cumulative chylous output (resection to ablation) averaged 28 L/patient. A modified technique is detailed, which utilizes direct puncture of groin lymph nodes to facilitate opacification of the thoracic duct. CONCLUSIONS: Percutaneous embolization strategies to treat chylothorax should be considered initial therapy before reoperation and direct ligation. Opacification of the thoracic duct to facilitate direct transhepatic cannulation can be accomplished with direct lymph node cannulation in the groin. Successful ablation of chylothorax following percutaneous embolization is predictable in a high percentage of cases. (C) 2015 Elsevier Inc. All rights reserved.

    Journal Title

    American Journal of Surgery

    Volume

    209

    Issue/Number

    2

    Publication Date

    1-1-2015

    Document Type

    Article

    Language

    English

    First Page

    235

    Last Page

    239

    WOS Identifier

    WOS:000349720500003

    ISSN

    0002-9610

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