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Thoracoscopic Surgery for Chylothorax
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Chylothorax is a potentially life-threatening disease that often requires surgical intervention in dogs. Thoracic duct ligation (TDL) is most commonly performed, and can be achieved via open thoracotomy, thoracoscopy, or a trans-diaphragmatic approach.1-4 Thoracic surgery, however, carries an inherent risk of anesthetic and surgical complications, and is often associated with postoperative discomfort or pain, requiring several days of hospitalization. Moreover, thoracic duct ligation often requires adjunctive procedures (e.g. pericardectomy) to achieve complete resolution of chylous effusion. Thoracic duct ligation is currently the most common surgical treatment for dogs with chylothorax. This procedure requires direct access to the thoracic duct and can be performed via thoracotomy, thoracoscopy, or a transdiaphragmatic (paracostal) approach. Complications associated with thoracic surgery include pain, hemorrhage, infection, dehiscence, hypoxemia, and pneumothorax.5,6 Furthermore, thoracic duct ligation will only result in clinical resolution as a stand-alone therapy in approximately 50% of cases.1 Persistent chylothorax after ligation is thought to occur due to the formation of collateral lymphatics and the failure to ligate all branches of the thoracic duct. Thoracic duct ligation is therefore often combined with adjuvant procedures, often requiring multiple surgical approaches, to achieve higher success rates.2-8 [...]
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Affiliation of the authors at the time of publication
Associate Professor, College of Veterinary Medicine University of Florida Small Animal Clinical Sciences Gainesville, Florida, USA
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