Minimally invasive treatment of idiopathic chylothorax in dogs by thoracoscopic thoracic duct ligation and subphrenic pericardiectomy: 6 cases (2007–2010)

Abstract

To describe a technique and evaluate the outcome of thoracoscopic thoracic duct ligation (TDL) and subphrenic pericardiectomy (SPP) for treatment of idiopathic chylothorax (IC) in dogs. Retrospective case series. 6 client-owned dogs. Medical records of dogs with a diagnosis of IC that were subsequently treated by thoracoscopic TDL and SPP and that had not undergone previous surgical treatment were reviewed. Thoracoscopic TDL was performed via a 3-portal technique with the patient in lateral recumbency. Subphrenic pericardiectomy was subsequently performed via a 3-portal technique with the patient in dorsal recumbency. If visualization during SPP was suboptimal, 1-lung ventilation was used to ensure that pericardial resection was close to the phrenic nerves bilaterally but without risk of iatrogenic nerve injury. All TDL and SPP procedures were completed successfully in a median surgical time of 177 minutes (range, 135 to 210 minutes). All 6 dogs showed resolution of clinical signs of chylothorax with no recurrence during a median follow-up period of 39 months (range, 19 to 60 months). Final postoperative thoracic radiographic evaluation was performed at a median of 14.5 months (range, 7 to 25 months). Complete resolution of pleural effusion occurred in all but 1 dog. In 1 dog, a small volume of pleural effusion was persistent at a 7-month postoperative radiographic follow-up but was not associated with clinical signs and did not require thoracocentesis at any time during the dog's 25-month follow-up period. From this limited series of patients, results suggested that a minimally invasive TDL-SPP combined surgical technique for management of IC in dogs may be associated with a similarly successful outcome as has been reported for open surgical TDL-SPP.