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Spontaneous closure of a chylous fistula is usual, but the rare intractable fistula may lead to disastrous nutritional and immunological consequences. We report the surgical management of 5 patients with intractable fistulas with daily drainage averaging 2,060 ml. Conservative therapy failing, the 5 patients underwent 6 ligations of the thoracic duct. A limited posterolateral thoracotomy was used in 3, full right thoracotomy in 2, and left thoracotomy in 1. Ligations were carried out immediately above the diaphragm, and not at the fistula site, by a mass ligature technique encircling all tissue between the azygos vein and aorta. The ligation achieved immediate cessation of drainage in four of five initial procedures and in the fifth patient, at a second operation. High-output thoracic duct fistulas may be handled by supradiphragmatic ligation of the thoracic duct. Identification of the fistula site or the dissection of the thoracic duct itself is avoided by this technique.
G A Patterson, and
T R Todd, and
N C Delarue, and
R Ilves, and
F G Pearson, and
J D Cooper
May 2009,
The Annals of thoracic surgery,
G A Patterson, and
T R Todd, and
N C Delarue, and
R Ilves, and
F G Pearson, and
J D Cooper
July 1948,
Annals of surgery,
G A Patterson, and
T R Todd, and
N C Delarue, and
R Ilves, and
F G Pearson, and
J D Cooper
July 1948,
Annals of surgery,
G A Patterson, and
T R Todd, and
N C Delarue, and
R Ilves, and
F G Pearson, and
J D Cooper
January 2010,
Interactive cardiovascular and thoracic surgery,
G A Patterson, and
T R Todd, and
N C Delarue, and
R Ilves, and
F G Pearson, and
J D Cooper
April 1975,
IMJ. Illinois medical journal,
G A Patterson, and
T R Todd, and
N C Delarue, and
R Ilves, and
F G Pearson, and
J D Cooper
May 2006,
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery,
G A Patterson, and
T R Todd, and
N C Delarue, and
R Ilves, and
F G Pearson, and
J D Cooper
November 1953,
Medical bulletin (Ann Arbor, Mich.),
G A Patterson, and
T R Todd, and
N C Delarue, and
R Ilves, and
F G Pearson, and
J D Cooper
February 1977,
The Australian and New Zealand journal of surgery,
G A Patterson, and
T R Todd, and
N C Delarue, and
R Ilves, and
F G Pearson, and
J D Cooper
April 2009,
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G A Patterson, and
T R Todd, and
N C Delarue, and
R Ilves, and
F G Pearson, and
J D Cooper
January 2004,
ORL; journal for oto-rhino-laryngology and its related specialties,
