Efficacy of en bloc thoracic duct ligation in combination with pericardiectomy by video‐assisted thoracoscopic surgery for canine idiopathic chylothorax. (27th December 2019)

• Record Type: Journal Article
• Authors: Kanai, Hiroo; Furuya, Masaru; Hagiwara, Ken; Nukaya, Aya; Kondo, Motoki; Aso, Toshihide; Fujii, Ayako; Sasai, Kazumi
• Is Part Of: Veterinary surgery. Volume 49:(2020)Supplement 1
• Page Start: O102
• Page End: O111
• Publication Date: 2019-12-27
• Subjects: Veterinary surgery -- Periodicals; Veterinary Medicine -- Periodicals; Surgery -- Periodicals; Societies, Medical -- Periodicals; 636.0897
• DOI: 10.1111/vsu.13370
• Languages: English
• ISSNs: 0161-3499

Abstract

Abstract: Objective: To compare the outcomes of pericardiectomy performed with conventional clipping thoracic duct ligation (C‐TDL) to those with en bloc thoracic duct ligation (EB‐TDL) using video‐assisted thoracoscopic surgery (VATS) for canine idiopathic chylothorax. Study design: Retrospective consecutive case series. Animals: Thirteen client‐owned dogs with idiopathic chylothorax. Methods: Medical records of dogs treated with pericardiectomy in combination with TDL by VATS without intraoperative contrast were reviewed. Five and seven dogs underwent C‐TDL and EB‐TDL, respectively, and 11 dogs were evaluated by preoperative and 7‐ to 10‐days‐postoperative computed tomography‐lymphography (CTLG). No clinical symptoms with absent or minimal pleural effusion was defined as clinical improvement. Long‐term remission (LTR) was defined as rapid resolution of pleural effusion and no recurrence for more than 1 year. Anesthesia time, operation time, the duration of hospitalization, and time until pleural effusion resolution were compared. Results: Clinical improvement was achieved in 91.7% of the cases (C‐TDL, 4/5; EB‐TDL, 7/7), excluding one case of intraoperative death. The LTR rate was significantly higher with EB‐TDL (6/7 [85.7%]) than with C‐TDL (1/5 [20%]). Anesthesia time, operation time, and time until pleural effusion resolution were significantly better with EB‐TDL than with C‐TDL. The rates of thoracic ducts visualization by postoperative CTLG were 100% (5/5) with C‐TDL and 42.9% (3/7) with EB‐TDL. Conclusion: En bloc TDL was an effective treatment for canine idiopathic chylothorax in this patient population. It compared favorably to C‐TDL, although missed branches at the time of surgery may explain the difference between C‐TDL and EB‐TDL in this small population of cases. Clinical significance: En bloc TDL by VATS was an effective minimally invasive treatment for canine idiopathic chylothorax. Computed tomography‐lymphography can be used for surgical planning and postoperative evaluation.