Transdiaphragmatic approach to thoracic duct ligation in the cat.

Abstract

An approach combining ventral midline celiotomy with transdiaphragmatic thoracotomy was evaluated in eight healthy cats for ligation of the thoracic duct system. Evans Blue solution was injected into the right colic lymph node to outline the intestinal lymphatic trunk and the thoracic duct system. Three cats (group 1) had mesenteric lymphangiograms and three (group 2) had only lymph node dye injection before thoracic duct ligation. The thoracic duct system was ligated with hemostatic clips just cranial to the aortic hiatus of the diaphragm, through a left transdiaphragmatic thoracotomy. Two cats (group 3) had prethoracotomy mesenteric lymphangiograms and thoracic duct isolation without ligation. Mesenteric lymphangiography was performed immediately after the surgery. In all of the cats, an absence of contrast medium in the thoracic duct system cranial to the surgical site was interpreted as complete obstruction. Four weeks after ligation, there was complete obstruction of the thoracic duct system with alternate lymphaticovenous communications in four of the six cats with ligated thoracic duct systems. Partial obstruction of the thoracic duct system with alternate lymphaticovenous communications was present in the other two cats. Both cats without thoracic duct ligation had patent thoracic duct systems. At necropsy of the six cats with ligated thoracic ducts, there was mild focal lymphadenitis of injected lymph nodes in three cats. The wall of the aorta adjacent to the hemostatic clips was normal in all six cats. The surgical technique was simple and provided excellent exposure. Vital staining with Evans Blue helped visualize the thoracic duct system, but mesenteric lymphangiography did not. Postligation lymphangiography was not of value in identifying incomplete ligation.