Posterior retroperitoneoscopic thoracic duct ligation: a novel surgical approach



Treatment of postoperative chylothorax can be challenging. Conservative treatment and/or surgical management by means of open or minimally invasive thoracic duct ligation for persistent chylothorax are accepted therapeutic options. We present a new retroperitoneoscopic approach for thoracic duct ligation.


Between January 2006 and May 2017, posterior retroperitoneoscopic thoracic duct ligation was performed in four patients. The thoracic duct was identified transdiaphragmatically and ligated cranially to the cisterna chyli using absorbable clips.


Retroperitoneoscopic ligation resulted in a complete and lasting chylothorax resolution in three patients and marked improvement in a fourth one. Mean operative time was 86 min (range 40–135). There were no perioperative or postoperative complications.


Retroperitoneoscopic thoracic duct ligation is feasible and safe. It allows for a precise anatomical exploration of the thoracic duct caudally to the chyle leak, avoiding the previous operative field and resulting in minimal morbidity. In patients with persistent chylothorax, our approach provides an additional therapeutic option.

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The authors are grateful to Catherine Cers-Meunier for illustrating the anatomical features, to Carlos Alves for video editing, and to Christopher Burel, Guy Temporal, and Iana Shutrova for their valuable assistance in proofreading the manuscript.


No external funding has been received to support this study.

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Correspondence to B. Seeliger.

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Drs. Barbara Seeliger, Pier F. Alesina, and Martin K. Walz have no conflicts of interest or financial ties to disclose.

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Seeliger, B., Alesina, P.F. & Walz, M.K. Posterior retroperitoneoscopic thoracic duct ligation: a novel surgical approach. Surg Endosc 32, 3732–3737 (2018) doi:10.1007/s00464-018-6262-5

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  • Chylothorax
  • Chyle leak
  • Thoracic duct
  • Retroperitoneoscopic ligation