Feasibility of combined minimally invasive thoracic duct ligation, cisterna chyli ablation, and subphrenic pericardiectomy in canine chylothorax.

The objective of this study, which is part of a retrospective case series, was to report on single-session, minimally invasive thoracic duct ligation (TDL), cisterna chyli ablation (CCA), and partial pericardiectomy (PPE) for dogs with chylothorax. A total of 9 client-owned dogs with chylothorax participated in the study. A right-sided or bilateral thoracoscopic and left-flank laparoscopic approach was carried out in sternal recumbency for TDL and CCA, respectively. Subsequent partial pericardiectomy was done thoracoscopically via a paraxiphoidal approach. Combined (TDL, CCA, and PPE), minimally invasive treatment was successful in all cases. Intraoperative complications mostly occurred during the PPE phase and all were managed without long-term sequalae. Seven of 9 cases had resolution of chylothorax after the surgical procedures. Two dogs had persistent chylothorax and were euthanized. A dog with concomitant atrial fibrillation was euthanized 140 d post-operatively because of severe abdominal effusion. During short-term follow-up, 2/6 cases received limited additional drainage events for non-chylous effusion. Long-term follow-up revealed late recurrence of chylothorax in 1 dog. Median survival time was 183 d (range: 3 to 2051 d) post-operatively. Minimally invasive treatment using TDL, PPE, and CCA was feasible by a single-session, combined procedure, seemingly without significant treatment-related complications. Several cases had excellent long-term outcomes. Minimally invasive, combined TDL, CCA, and PPE is feasible as treatment of chylothorax, with excellent long-term outcomes possible. However, larger clinical cohorts must be studied to assess additional benefits of the combined treatment and the clinical effect of CCA.