Rahim Mahmodlou1, Awat Yousefiazar2

1Department of General Surgery, Urmia University of Medical Sciences, Urmia, Iran
2Department Anesthesia and Surgical Technology, Urmia University of Medical Sciences School of Allied Medical Sciences, Urmia, Iran


Objective: Chylothorax (CTx) is the leak and accumulation of lymphatic fluid within the pleural cavity. The incidence of CTx has the highest rate after esophagectomy. This study aimed to present three cases of post-esophagectomy chylothorax among 612 esophagectomies that were performed over 19 years, in which post-esophagectomy chylothorax was reviewed in terms of risk factors, diagnosis, and management.

Material and Methods: Six hundred and twelve patients were included in the study. Transhiatal esophagectomy was used for all patients. In three cases, chylothorax was detected. In all of the three cases, secondary surgery was performed for the management of chylothorax. Mass ligation was performed for the first and third cases having leak from the right side. In the second case, the leak was from the left side without prominent duct; and despite mass ligation that was done several times, no significant reduction in chyle was observed.

Results: In the first case, in spite of reduced output, the patient gradually progressed to respiratory distress. His condition deteriorated over time and he died after three days. In the second case that needed third surgery, the patient’s condition deteriorated and she died after two days due to respiratory failure. The third patient had postoperative recovery. The patient was discharged on fifth day after the second operation.

Conclusion: In post-esophagectomy chylothorax, the key to preventing high mortality rates can be the identification of risk factors as well as timely detection of symptoms and proper management. Besides, early surgical intervention should be considered to prevent early complications of chylothorax.

Keywords: Chylothorax, transhiatal esophagectomy, post-esophagectomy chylothorax

Cite this article as: Mahmodlou R, Yousefiazar A. Incidence of chylothorax over nineteen years of transhiatal esophagectomy: A case series and review study. Turk J Surg 2022; 38 (4): 401-408.


Ethics Committee Approval

This study was approved by Urmia University Medical Sciences Research Ethics Committee (Decision no: IR.UMSU. REC.1401.324, Date: 02.11.2022).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept – RM; Design – RM, AY; Supervision – RM; Data Collection and/ or Processing – RM, AY; Analysis and/or Interpretation – RM, AY; Literature Search – RM, AY; Writing Manuscript – RM, AY; Critical Reviews – RM.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.