Minimally invasive surgical management of chylothorax complicating esophagectomy

Chylothorax is a rare complication of esophagectomy associated with increased morbidity and mortality. Prophylactic thoracic duct ligation is generally recommended during transthoracic esophagectomy, but despite this strategy chyle leak can occur. A possible explanation is that in up to 40% of individual the anatomical route of the thoracic duct is anomalous. A two-week wait and see policy with total parenteral nutrition and pleural drainage appears to be justified in patients with a chyle output of less than 1,000 mL per day. The introduction of video-assisted thoracic surgery has offered a safe and effective therapeutic alternative in these patients. We recommend primary en-bloc stapling of the thoracic duct through a right thoracoscopic approach in the semi-prone position.