A case of post-esophagectomy chylothorax successfully treated by thoracoscopic clipping of the thoracic duct Nobuyasu SUZUKI 1 , Yoshinao TAKANO 1 , Naoaki KANETA 1 , Ayaka AZAMI 1 , Yukitoshi TODATE 1 , Mitsuru WARAGAI 1 1Department of General Surgery, Southern TOHOKU Research Institute for Neuroscience Southern TOHOKU General Hospital Keyword: 乳び胸 , 食道癌術後 , 胸腔鏡 pp.205-212
Published Date 2018/3/15
DOI https://doi.org/10.11477/mf.4426200533
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Thoracoscopic clipping of the thoracic duct was successfully performed for the treatment of postoperative chylothorax. The case was a 65-year-old male. He visited our hospital for the chief complaint of a feeling of blockage during swallowing. He was diagnosed as esophageal carcinoma, T3N0M0 Stage Ⅲ. Subtotal esophagectomy by right thoracotomy, retrosternal gastric tube reconstruction, and three-field lymph node dissection was performed after 2 courses of preoperative chemotherapy (FP). The thoracic duct was resected during the operation and the stump was ligated by double transfixing suture. On postoperative day(POD)2, enteral nutrition was initiated. On the following day, pleural effusion drainage markedly increased. On POD 4, the fluid in the chest tube turned into a milky appearance and the patient was diagnosed with chylothorax. Following unsuccessful conservative therapy for 5 weeks, we performed thoracoscopic surgery to examine the thoracic duct and found a transudation point of chylous fluid. An additional clip was performed on the thoracic duct. The drainage gradually decreased after surgery. The chest tube was removed on POD 48 after the first surgery. Thoracoscopic surgery in the prone position was a less invasive and useful procedure for identifying the transudation points and clipping of chylothorax cases, even in thoracotomy approaches.

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