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E Ancona - One of the best experts on this subject based on the ideXlab platform.

  • prophylactic thoracic duct mass ligation prevents Chylothorax after transthoracic esophagectomy for cancer
    2009
    Co-Authors: Matteo Cagol, Alberto Ruol, Carlo Castoro, Rita Alfieri, Silvia Michieletto, E Ancona
    Abstract:

    Background Chylothorax after transthoracic esophagectomy for cancer is an uncommon but potentially lifethreatening postoperative complication. It has been reported that preventive thoracic duct ligation can reduce the incidence of postoperative Chylothorax after esophagectomy for cancer. In this prospective series, we evaluated the results of preventive intraoperative thoracic duct mass ligation in patients who underwent transthoracic esophagectomy for cancer. Methods From 2001 to 2006, 323 patients underwent transthoracic esophagectomy for cancer and duct ligation during the operation was routinely performed. Results No intraoperative or postoperative complications directly related to the procedure were recorded. No postoperative Chylothorax was observed. Conclusions In this series, the technique of intraoperative thoracic duct mass ligation proved to be safe and effectively prevented postoperative Chylothorax in patients who underwent transthoracic esophagectomy for cancer.

  • Chylothorax complicating esophagectomy for cancer a plea for early thoracic duct ligation
    2000
    Co-Authors: Stefano Merigliano, Daniela Molena, Alberto Ruol, Giovanni Zaninotto, Matteo Cagol, S Scappin, E Ancona
    Abstract:

    Abstract Objective: Postoperative Chylothorax remains an uncommon but potentially life-threatening complication of esophagectomy for cancer, and the ideal management is still controversial. The aim of the study was to compare the outcomes of patients treated nonoperatively with those of patients promptly undergoing reoperation. Methods: From 1980 to 1998, 1787 esophagectomies for esophageal or cardia cancer were performed, and 19 (1.1%) patients had postoperative Chylothorax. We analyzed type of operation, surgical approach, delay of diagnosis of Chylothorax, daily chest tube output, type of management, major complications, death, hospital stay, and final outcome. Results: Of the 19 patients with Chylothorax, 11 were initially managed nonoperatively (group A): 4 (36%) patients had spontaneous resolution of Chylothorax, and the other 7 required reoperation for the persistence of a high-volume output. There were three infectious complications and one postoperative death in this group. No reliable predictive criteria of successful versus unsuccessful nonoperative management could be found. The 8 most recent patients underwent early reoperation (group B). All patients recovered, and no major complications possibly related to Chylothorax or hospital deaths were observed. They were discharged after a median of 22 days (range, 12-85 days) compared with a median of 36 days (range, 21-64 days) for patients of group A. Conclusions: Early thoracic duct ligation is the treatment of choice for Chylothorax occurring after esophagectomy. Reoperation should be performed immediately after the diagnosis is made to avoid the complications related to nutritional and immunologic depletion caused by prolonged nonoperative treatment. (J Thorac Cardiovasc Surg 2000;119:453-7)

Tarek Hassanein - One of the best experts on this subject based on the ideXlab platform.

  • transjugular intrahepatic portosystemic shunt creation as treatment for refractory chylous ascites and Chylothorax in a patient with cirrhosis
    2004
    Co-Authors: Thomas B Kinney, Stephen Ferrara, Franklin J Miller, Anne C Roberts, Tarek Hassanein
    Abstract:

    The etiology of Chylothorax is usually considered to consist of four major categories: tumors, trauma, idiopathic conditions, and miscellaneous conditions. It appears that Chylothorax is a rare and underreported manifestation of cirrhosis resulting from transdiaphragmatic passage of chylous ascites. This condition can be debilitating as a result of respiratory compromise from a large volume of pleural fluid, as well as metabolic derangements, malnutrition, and immunologic impairment from loss of vital lymphatic constituents. Herein the authors present a case of a 46-year-old male patient with cirrhosis and complications of high-volume chylous ascites and Chylothorax who was successfully treated with creation of a transjugular intrahepatic portosystemic shunt.

Tetsuya Higami - One of the best experts on this subject based on the ideXlab platform.

Dongil Gwon - One of the best experts on this subject based on the ideXlab platform.

Edgardo Pezzetta - One of the best experts on this subject based on the ideXlab platform.

  • video assisted right supradiaphragmatic thoracic duct ligation for non traumatic recurrent Chylothorax
    2006
    Co-Authors: Michel Christodoulou, Hansbeat Ris, Edgardo Pezzetta
    Abstract:

    Background: Chylothorax is an uncommon disorder with respiratory, nutritional and immunological manifestations. Surgical management is indicated in case of recurrence or failure after conservative treatment. We report our experience with video-assisted right-sided supradiaphragmatic thoracic duct ligation for non-traumatic, non-postoperative persistent or recurrent Chylothorax. Patients and methods: The medical records of six patients operated at our institution between 1999 and 2004 were retrospectively reviewed. A right-sided Chylothorax was found in four patients, a left-sided in one, and a bilateral in one. Three patients developed Chylothorax after chemotherapy and chest irradiation for malignant diseases (lymphoma in two patients and breast cancer in one), one in the context of lymphangioleiomyomatosis, one due to a nondiagnosedlymphoma,andoneafterhearttransplantation.Results: Themeanoperativetimewas102 min,withanaveragelengthofhospitalstay of 14 days. Persistent cessation of chylous effusion within 7 days after surgery was observed in 5/6 patients without recurrence during a mean follow-up time of 41 months. One patient with undiagnosed mediastinal lymphoma required re-operation and thoracic duct ligation on day 8 by right-sided thoracotomy due to persistent Chylothorax. No 30-day mortality was recorded. Two patients presented postoperative complications including respiratory insufficiency requiring mechanical ventilation in one, and chylous ascites development requiring peritoneo-venous LeVeen shunting in one patient. Conclusions: Recurrent or persistent non-traumatic Chylothorax may be successfully treated by video-assisted right supradiaphragmatic thoracic duct ligation. # 2006 Elsevier B.V. All rights reserved.