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Long‐term outcome of video‐assisted thoracoscopic thoracic duct ligation and pericardectomy in dogs with chylothorax: A multi‐institutional study of 39 cases
- Mayhew, Philipp D., Steffey, Michelle A., Fransson, Boel A., Johnson, Eric G., Singh, Ameet, Culp, William T. N., Brisson, Brigitte A., Oblak, Michele L., Balsa, Ingrid M., Giuffrida, Michelle A.
- Veterinary surgery 2019 v.48 no.S1 pp. O112
- cardiac arrest, chylothorax, dogs, image analysis, medical records, pericardium, pleurisy, retrospective studies, surgery, thoracic duct
- OBJECTIVE: To evaluate the long‐term outcome of video‐assisted thoracoscopic (VATS) thoracic duct ligation (TDL) and pericardectomy for treatment of chylothorax in dogs. STUDY DESIGN: Multi‐institutional retrospective study. ANIMALS: Thirty‐nine client‐owned dogs. METHODS: Dogs were included if they had undergone a VATS TDL and pericardectomy and had at least 1‐year follow‐up or had died within 1 postoperative year. Medical records were evaluated, and recorded data included clinicopathological and diagnostic imaging results, surgical findings, complications, conversion rates, and long‐term resolution and recurrence rates. RESULTS: Thirty‐nine dogs met the inclusion criteria. Two dogs died intraoperatively; 1 was euthanized after severe restrictive pleuritis was diagnosed intraoperatively, and 1 underwent ventricular fibrillation and cardiac arrest during pericardectomy and could not be resuscitated. Conversion to an open approach was required in 1 of 39 (3%) dogs for TDL and 4 of 36 (11%) dogs for pericardectomy. Overall follow‐up time was median 38 months (range, 3‐115). Resolution of pleural effusion occurred in 35 of 37 (95%) dogs that survived the perioperative period. Late recurrence of pleural effusion was seen at 12, 12, and 19 months postoperatively in 3 of 35 (9%) dogs that survived the perioperative period and in which chylothorax had initially resolved. CONCLUSION: Successful long‐term resolution of chylothorax was seen in a high proportion of dogs that underwent VATS TDL and pericardectomy, although late recurrence was sometimes seen. CLINICAL SIGNIFICANCE: Video‐assisted thoracoscopic thoracic duct ligation and pericardectomy are highly successful in dogs with chylothorax. Future studies should evaluate whether pericardectomy is required in dogs without evidence of pericardial disease.