A Case of Chylothorax after Esophagectomy Treated with Laparoscopic Assisted Thoracic Duct Ligation in its Early Stage

Abstract

A 72-year-old woman who had undergone endoscopic submucosal dissection (ESD) for esophageal cancer developed local recurrence half a year after ESD, and esophagostomy was performed. From the day after the operation, the drainage amount of the chest drain exceeded 1,000 ml/day, and the chest drainage changed to milky white in color. She was thus diagnosed with chylothorax. We started the treatment with octreotide and etilefrine, but no improvement was obtained. Furthermore because of nausea, which is an adverse side effect of octreotide, the administration of octreotide had to be withdrawn. Therefore, we decided to convert to surgical treatment and performed small laparotomy and laparoscopic-assisted trans-hiatal thoracic duct ligation. The volume of chylothorax remarkably decreased, and on the second day after re-operation, the amount of drainage was less than 500 ml/day. She was discharged on the 18th POD. Conservative treatment is often the first choice for initial treatment for chylothorax after surgery for esophagus cancer. If this is not effective, invasive treatments including surgical treatment are selected. Although re-operation is not minimally invasive, early intervention could reduce the hospital days and shorten the time to start oral intake. It should be important to select the proper treatment at an appropriate time.