Thoracic Duct Injury Following Esophagectomy in Carcinoma of the Esophagus: Ligation by the Abdominal Approach

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2012 Oct 18

PMID 23073504

Citations 13

Authors

Pramod Kumar Mishra

Sundeep Singh Saluja

Dinesh Ramaswamy

Satinderpal Singh Bains

Parvez David Haque

Affiliations

Soon will be listed here.

Abstract

Background: Thoracic duct injury (TDI) is a potentially lethal complication of esophagectomy. There is no consensus regarding when and how to intervene in these injuries. Both thoracic and abdominal approaches have been used.

Methods: Esophagectomies performed for cancer of the esophagus (n = 104) from October 2003 to July 2011 were analyzed for TDI. Diagnosis, histological type, stage, and location of tumor, neoadjuvant therapy, trans-thoracic or trans-hiatal procedure performed, nature and amount of drain output, and levels of triglyceride in the effluent were analyzed. Management of these injuries and morbidity and mortality associated with the approach taken were reviewed.

Results: We observed chylothorax in 9 patients. All nine patients had undergone trans-hiatal esophagectomy. All patients eventually required surgical intervention. Mass ligation of the thoracic duct was performed via the thoracic route in three patients and via the trans-abdominal approach in six others. Thoracic duct ligation was successful in all patients. One patient required a second laparotomy and repeat ligation of the duct. There were two postoperative deaths; both these patients had ligation by the thoracic route.

Conclusions: Trans-abdominal ligation of the thoracic duct in patients with chylothorax after esophagectomy is technically easy and safe. It may be preferred over the trans-thoracic approach, especially after an initial trans-hiatal esophagectomy.

Citing Articles

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Transhiatal bilateral thoracic duct ligation for duplicated thoracic duct injury after esophagectomy: a case report.

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Franceschilli M, Argiro R, Siragusa L, Usai V, Sibio S, Di Carlo S Am J Case Rep. 2022; 23:e936590.

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