Idiopathic chylothorax in dogs is a complex disorder that causes the accumulation of chyle within the pleural space, resulting in respiratory distress and, in some cases, restrictive pleuritis. Nonidiopathic cases can be associated with a variety of underlying conditions, all of which should be ruled out prior to making the diagnosis of the idiopathic form of the disease. In idiopathic cases, many treatment modalities, both medical and surgical, have been proposed for management of this challenging condition. Medical treatment with benzopyrones, low-fat diets, and medium-chain triglycerides with or without intermittent pleural drainage is often discussed but is generally not highly successful, and no large studies exist reporting encouraging results with nonsurgical management. A large variety of surgical options have been investigated either in isolation or in combination in a small number of dogs. They include TDL (individual or en bloc ligation),1–7 pericardiectomy,5,7,8 thoracic cavity omentalization,9–11 cisterna chyli ablation,6 thoracic duct and cisterna chyli embolization,12,a pleurodesis,13,b and pleurovenous or pleuroperitoneal shunting.14,15 Thoracic duct ligation and SPP has been reported to have a high success rate in dogs when performed through 1 or 2 intercostal thoracotomies.5,7
A general trend toward increased use of minimally invasive procedures is occurring in veterinary surgery and may offer great advantages to patient care. However, at the time of the study reported here, little objective evidence existed documenting the benefits of minimally invasive versus open thoracic procedures. One study16 of dogs undergoing partial pericardiectomy demonstrated a decrease in signs of pain and analgesic requirement in the minimally invasive group, compared with results for the open surgical group. If minimally invasive procedures are to be become more widespread, it must be shown that their efficacy and safety can match or surpass published results for open surgical counterparts. Only 1 study8 exists in the veterinary literature documenting the results of a minimally invasive surgical approach for management of naturally occurring IC in 7 dogs. The objective of the study reported here was to report the technique used, complications, and outcome for dogs that underwent minimally invasive TDL and SPP for the treatment of IC.
Thoracic duct ligation
Weisse CA, Berent AC, Solomon JA, et al. Initial short-term experience with cisterna chyli and thoracic duct glue embolization for idiopathic chylothorax in 2 dogs and 1 cat (abstr). Vet Surg 2010;39(suppl 1):E59.
Orsher RJ, Harvey CE. Tetracycline sclerotherapy (pleurodesis) for the treatment of chylothorax in the dog (abstr). Vet Surg 1990;19:72–73.
Endotip cannula, Karl Storz Veterinary Endoscopy Inc, El Segundo, Calif.
Thoracoport cannula, Auto Suture International Inc, Norwalk, Conn.
Alexis, Applied Medical Inc, Rancho Santa Margarita, Calif.
Ligasure V Sealer/Divider, 10 mm, Valleylab Inc, Boulder, Colo.
ML/10, Microline Surgical Inc, Beverly, Mass.
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