Thoracovenous shunt as therapy of post-operative chylothorax following transthoracic esophagectomy

Chylothorax is an infrequent complication of esophagectomy (0.6-3.9%). We report a case of chylothorax occurring after subtotal transthoracic esophagectomy with thoracic and abdominal lymphadenectomy in a patient with a squamous cell carcinoma of the esophagus. Initially the 55-year-old man was treated with conservative procedures for 2 weeks. After these had failed, a thoracotomy with ligature of the sinistral lymphatics was carried out. Since clinical and radiologic findings did not improve, a thoracovenous implantation of the Denver shunt system (Denver Biomaterials, Inc., Evergreen, Colorado, USA) was performed. No early complication was recognized in the peri-operative period. The subsequent course showed a good compensation of the lymphatic fistulas, with minimal rest effusions on both sides. Thoracovenous shunting may offer an effective and reasonable therapy after failure of conservative treatment and thoracic duct ligation in exceptionable cases if pleuroperitoneal deviation does not appear suitable.