Single Paracostal Approach to Thoracic Duct and Cisterna Chyli: Experimental Study and Case Series


  • Presented in part at the Society of Veterinary Soft Tissue Surgery 9th Annual Scientific Meeting, Steamboat, CO, June 10, 2010.

Corresponding Author

Bryden J. Stanley, BVMS, MVetSc, Diplomate ACVS, Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824




To-determine the feasibility of a single paracostal abdominal approach for thoracic duct ligation (TDL) and cisterna chyli ablation (CCA) in dogs with chylothorax.

Study Design

Observational study and prospective case series.


Normal dogs (n = 5) and dogs with chylothorax (n = 8).


A single paracostal approach with transdiaphragmatic extension for TDL and CCA was developed experimentally (n = 5) and used in 8 clinical cases with subtotal pericardectomy (SPE) performed in 4 dogs. Surgery time, complications, hospitalization time, outcome, and follow-up of clinical cases were recorded.


Exposure of relevant anatomy was excellent; vital lymphatic staining facilitated identification of lymphatic structures. In clinical cases, mean surgery time for TDL + CCA was 136 minutes. Mean hospitalization time was 3.1 days. Seven of 8 cases survived, with 1 dog dying of heart failure shortly after discharge. One dog required a second (left) paracostal approach to ligate 2 more lymphatic vessels. On follow-up (median, 7 months; range, 2–20 months), there was complete resolution of chylothorax in 6 dogs.


A single paracostal approach provides excellent exposure of cisterna chyli, caudal thoracic duct, and intestinal lymphatics. This approach eliminates the need for repositioning during combined TDL + CCA procedures and avoids an intercostal thoracotomy.