Two weeks following the initial management of this patient's chylothorax there is persistent accumulation of chyle in the pleural space. Appropriate management at this time includes which of the following procedures?
Chylothorax May occur after intrathoracic surgery, or it may follow malignant invasion or compression of the thoracic duct. Intraoperative recognition of a thoracic duct injury is managed by double ligation of the duct. Injuries not recognized until several days after intrathoracic surgery frequently heal following the institution of a low-fat diet and either repeated thoracentesis or tube thoracostomy drainage. A low-fat, medium-chain triglyceride diet often reduces the flow of chyle. Failure of this treatment modality requires direct surgical ligation of the thoracic duct. This is best approached from below the diaphragm(Sub Diaphragmatic)
Neck exploration and ligation of the thoracic duct
Subdiaphragmatic ligation of the thoracic duct
Thoracotomy and repair of the thoracic duct
Thoracotomy and ligation of the thoracic duct
Lymphatic System