A thorascopic chylothorax surgery is a minimally invasive alterative to traditional thoracic surgery for the treatment of chylothorax. Chylothorax is a condition where chylous fluid (lymphatic fluid) accumulates inside the chest cavity (thoracic effusion). This condition is rare and is seen in both dogs and cats. In most cases there is no underlying cause and it is considered to be idiopathic. Medical management of chlyothorax is rarely successful in resolving the disease and surgical intervention is often recommended. The surgical goal is to eliminate the accumulation of the chylous fluid inside the chest allowing patients to breathe more easily.
Why it’s done
Your veterinarian may recommend chylothorax surgery if your pet has:
- Weight loss
- Difficulty breathing
- Evidence of white or pink tinged fluid in the chest (chylous effusion)
How to prepare for your pet’s procedure
Before your pet’s procedure, you will meet with one of our specialists to talk about the procedure and what to expect.
When you meet with our team, please bring a list of all medications that your pet is currently taking, including over the counter medications, vitamins, and herbal supplements. Before your pet’s procedure, you may be asked to discontinue giving certain medications that can increase the risk of bleeding.
This is a good time to ask questions about the procedure and make sure you understand the risks and benefits.
Preoperative diagnostics and tests
Before your pet’s surgery the following may be indicated:
- Thoracocentesis (sampling and/or draining the chest fluid)
- Cardiac and/or thoracic ultrasound
- CT scan
- Comprehensive blood work
General Instructions for the Day of Surgery
- Please remove your pet’s access to food as of midnight the night prior to surgery, but do allow water all night long.
- Please arrive for pet’s admission promptly at your scheduled arrival time.
- You will be asked to sign both a Surgical Consent Form as well as an Estimate, indicating your understanding of the procedure, risks, and associated costs.
What happens during a thorascopic chylothorax surgical procedure?
Your pet will be given a general anesthetic. Special instruments, including a camera, are passed through small ½ inch incisions into the chest. Multiple surgical procedures are available to attempt to resolve the chylothorax and include thoracic duct ligation, cisterna chylii ablation (opening the cisterna chili in the abdomen), and pericardectomy (removing the heart sac). Contrast and dye are used to highlight the lymphatics to facilitate proper identification of the thoracic duct and cisterna chili. A small chest tube is placed for monitoring after surgery.
Complications associated with a thorascopic chylothorax surgery include the following:
- Continued chylous accumulation
- Contrast reactions, including: low blood pressure, anemia, kidney injury/failure (rare)
- Lung adhesions
After the procedure
- Following the procedure, you will be given a phone call with an update on your pet’s recovery.
- Please plan for your pet to remain hospitalized for pain management, supportive care, and monitoring for 1-2 days post operatively.
- You will be given daily updates regarding your pet’s progress during their stay.
- A scheduled discharge will be coordinated, when your pet is able to go home.
- Once discharged, please remove the bandage from your pet’s intravenous catheter site 10 to 15 minutes after arriving home.
- Some chest tenderness is common for 3-5 days following thorascopic surgery.
- It is important to restrict your pet’s activity for the next 3-5 days while the incision is healing. Walks should be short and your pet should always be on a leash. Please do not let your pet rough house with other animals during this time.
- Some patients will vomit or have diarrhea following anesthesia. If the vomiting or diarrhea persists more than 24 hours, please call Salt River. In contrast, some patients may be constipated or may not have a bowel movement for up to 72 hours following anesthesia. If your pet is straining to defecate after 72 hours, please call Salt River.
- Suture removal in 10-14 days is necessary
- Please monitor the incision for any signs of heat, pain, swelling, or discharge. Should you notice any of these signs, it may be an indication of infection. Please call Salt River if you notice a problem.
- Licking or scratching at the incision will dramatically increase the chances of an infection or that the incision will open up. To prevent this from happening, please watch your pet closely for scratching or licking at the incision. If this occurs, an e-collar should be placed.
The samples are submitted to a number of specialized laboratories for evaluation including the following tests:
- Bacterial cultures
The final biopsy results can take up to 2 weeks. Once the final results have returned and a treatment plan has been devised, our specialists will call you to discuss the findings and recommendations.
A recheck appointment is required in 1-2 weeks.