Open AccessClosure of the thoracic duct from the left-side access
Author(s) -
Paweł Nachulewicz,
Anna Golonka,
Tomasz Żądkowski,
Paweł Osemlak,
Joanużyńska-Flak,
Agnieszka Brodzisz,
Elżbieta Pac-Kożuchowska
Publication year - 2016
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000004552
Subject(s) - medicine , chylothorax , thoracic duct , pleurodesis , esophagus , surgery , mediastinum , pleural effusion , thoracoscopy , radiology , lymph , psychiatry
Background: We report a 16-year-old patient with a massive left-sided chylothorax after chemotherapy due to mixed germinal tumor of the testis with massive metastases located in the retroperitoneal space and posterior mediastinum. Chemotherapy resolved the metastases in the mediastinum but evoked a huge pleural effusion in the left pleural cavity, requiring surgical intervention. Left-sided access was used. The 5-mm camera and 3 5-mm working ports were inserted. The parietal pleura was incised and the esophagus located and protected. Behind the esophagus, the thoracic duct and concomitant tissue were clipped with titanium clips, and additionally, thrombin glue was used. Stopping of the lymph leakage was observed during surgery. A local argon pleurodesis was used to finish the procedure. The thoracic tube was removed on the third postoperative day. Conclusion: Left-side access may be a good alternative in the left-sided chylothorax, but the crucial points are location and protection of the esophagus during the procedure, which is also the landmark that allows for locating the thoracic duct.