Wall-E’s Story: Minimally Invasive Surgery to Treat Chylothorax

April 7, 2023

Wall-E is a 4-year-old Shiba Inu who had a 4-month history of lymph fluid accumulation in his chest (“chylothorax”), resulting in several visits to the ER for trouble breathing. After an extensive workup, no specific cause was identified for accumulation of the fluid, so it was deemed “idiopathic”, which is the most common cause of chylothorax in dogs. The treatment of choice for idiopathic chylothorax is a multistep surgical procedure, all of which can be performed in minimally invasive fashion. With surgery, further accumulation of lymph fluid in the chest is eliminated in 95% of cases, with only a 9% recurrence rate.

First, an approximately 3 cm incision into the abdomen is made to access specific lymph nodes to inject with a blue dye to highlight the duct (the “thoracic duct”) that carries lymph fluid from the back half of the body back to the heart. Next, thoracoscopy is performed to identify the thoracic duct above the aorta and gently dissect it away so that it can be ligated with several metal clips. Ligation of the thoracic duct encourages Wall-E’s body to form connections between the lymphatic system and the venous system so that lymph fluid will no longer have to travel through the chest to reach the heart, effectively eliminating the possibility of further lymph fluid accumulation in the chest. Last, to decrease the pressure on the right side of the heart and encourage lymph flow to the heart, the sac surrounding the heart, called the pericardium, is removed thoracoscopically. Thoracoscopy allows us to perform surgery through several small incisions roughly the size of a pencil eraser rather than through a large incision into the chest cavity.

Wall-E did wonderfully throughout surgery and anesthesia, and after a short hospital stay, he was discharged home. He was recently rechecked and is doing excellent! He has no fluid in his chest whatsoever and is back to his loving and energetic personality!

Laparoscopy on Wall-E