Abstract
Chylothorax is a rare but potentially serious complication after aortic surgery. We report the successful thoracoscopic ligation of a thoracic duct after persistent chylous drainage related to a prior aortic surgery. Briefly, a 70-year-old man underwent the open graft replacement of a descending thoracic aneurysm. He showed persistent drainage from his left-sided chest tube and also required a right-sided chest tube for a large pleural effusion identified on postoperative day 3. His bilateral pleural effusions as well as the character of the chest tube drainage was consistent with chylothorax. Drainage was persistent. Pleurodesis successfully treated his left side, but, after 22 days of conservative management, his right-sided chylothorax still persisted. Therefore, the patient underwent thoracoscopic ligation of the thoracic duct. Ligation was achieved via a right thoracoscopic approach. After the thickened parietal pleura at the level of the 11th thoracic vertebra was dissected free, the thoracic duct was exposed between the azygous vein and aorta before it was ligated. The patient exhibited no further chylous leakage. We conclude that a right-sided thoracoscopic thoracic duct ligation for persistent chylothorax after aortic surgery is safe and effective.
