Laparoscopic Cisterna Chyli Ablation Combined with Thoracoscopic Thoracic Duct Ligation and Pericardectomy in 5 Dogs and 2 Cats with Idiopathic Chylothorax

Abstract

Objective: To assess feasibility of a left-sided laparoscopic flank approach for cisterna chyli ablation (CCA) and evaluate effectiveness of a combination of en-block thoracic duct ligation (TDL), sub-phrenic pericardectomy (PC), and CCA in a minimally invasive approach for treatment of idiopathic chylothorax in dogs and cats. Methods: Dogs and cats diagnosed with idiopathic chylothorax were admitted for a minimally invasive surgical treatment combining TDL, PC, and CCA. Results: Five dogs and 2 cats received the minimally invasive combination treatment (TDL + PC + CCA). Two patients were treated for recurrent chylothorax after previous TDL + PC. TDL was performed in sternal recumbence with bilateral approach in 6 cases and unilateral in 1. CCA was successfully performed through a 2-portal left-sided flank approach in sternal recumbence. PC was performed in dorsal recumbence in 6 cases and sternal in 1 cat. Obvious lymph spillage from the cisterna chyli into the abdomen was noted during CCA in all patients. No intraoperative complications occurred. Post-operative complications included development of pyothorax in 1 patient after prolonged maintaining of a thoracic drain, which resolved with antibiotic treatment. Pleural effusion resolved in 4/7 patients (4/5 dogs); 3/7 were eventually euthanized because of continued chylothorax, including both cats. Conclusion: Laparoscopic CCA is feasible through a 2 portal left-sided flank approach in sternal recumbence and seemingly without complications. Further investigation is needed to assess specific value of a combination of all 3 therapies.