Recurrent chylothorax treated with thoracic duct–venous anastomosis: A retrospective review of medical records

OBJECTIVES: Clinically, recurrent chylothorax is challenging to solve, especially when chylothorax is still present after the thoracic duct is ligated. In this study we explored alternative surgical options to treat complex cases of recurrent chylothorax. METHODS: Clinical records, laboratory results, and magnetic resonance imaging scans were retrospectively reviewed for 3 patients with recurrent chylothorax who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from August 8, 2016, to October 30, 2019. Evidence from the surgical treatment of thoracic duct–venous anastomosis was assessed using pictures from the operation room, with follow-up until now. RESULTS: Thoracic duct ligation had failed twice in patient 1, and the other 2 patients each had thoracic duct ligation that failed once again. After undergoing thoracic duct ligation, all 3 patients showed a significant reduction in chest fluid, but their condition soon returned to the same as that before ligation. All 3 patients finally underwent thoracic duct–venous anastomosis. The changes in lymphocyte and granulocyte numbers in the blood system of the patients before and after the operation were not substantial, and the operations had little effect on liver and kidney function. The patients achieved satisfactory treatment results, with follow-up until the present (23-60 months). CONCLUSIONS: This research shows that thoracic duct–venous anastomosis is a safe and effective alternative surgical approach for complex recurrent chylothorax.