Anatomical Variations of Cervical Portion of Thoracic Duct and Management of Chyle Leak: Case report And Reviewof The Literature (original) (raw)
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Key points instead of abstract as per author guidelines: • Chyle leaks (CLs) following neck dissection for metastatic head and neck malignancy are infrequent but represent a serious complication, with an incidence of 1-2.5%. • CL is associated with significant morbidity including metabolic imbalance, immunosuppression, dehydration, poor wound healing and prolonged length of hospital stay. • A protocolised approach to the management of CL post neck dissections is highlighted for expedient patient management. • Thoracic duct (TD) ligation using video-assisted thoracoscopic surgery (VATS) is an effective method of treating moderate (500-1000ml/24 hours) to high-volume CL (>1000ml/24 hours) not responding to medical therapy. • VATS TD ligation is a safe procedure to treat CL. It has a low morbidity compared to other surgical techniques (neck re-exploration or open thoracotomy).
Annali italiani di chirurgia, 2020
Chyle leak is a major compication following head and neck surgery, with reported incidence of 0.5% up to 8.3% in published literature. Cervical chyle leak may be challenging to manage with significant morbidity, resulting from extensive fluid and nutritional losses. This manuscript presents four cases of cervical chyle leak after head and neck surgery. Cervical thoracic duct injury had been identified intra-operatively. Conservative treatment failed to reduce chylous output post-operatively. All patients were offered thoracocscopic thoracic duct ligation in prone position; thoracic duct was dissected above the right diaphragm and ligated. Immediate resolution of their symptoms followed, with no recurrence at the follow-up period. Intra-operative repair of cervical thoracic duct remains controversial, while when identified early reduces the following comorbidities. Conservative management addresses reduction of chylous output, while amplifying hydration and alimentation. Thoracoscopi...
Management of chyle leak post neck dissection: a case report and literature review
Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2011
Chyle leakage post head-and-neck resection is a rare but potentially life-threatening complication. Management may be problematic and prolonged. Recently, thoracoscopic ligation of the thoracic duct has emerged as a promising technique to definitively treat this difficult problem. We present a recent case of a hemimandibulectomy, radical modified neck dissection and osseocutaneous fibular-free-flap complicated by a chyle leakage. The chyle leak was successfully treated with thoracoscopic ligation of the thoracic duct. In the light of our clinical experience and following a thorough literature review, we have proposed that complicated or high-output chyle leaks (>1000 ml day(-1)) should be treated with early thoracoscopic thoracic duct ligation.
High output chyle leak after neck surgery: the role of video-assisted thoracoscopic surgery
British Journal of Oral and Maxillofacial Surgery, 2009
Injury to the thoracic duct leading to formation of a chylous fistula is an infrequent but serious complication of major neck surgery that can result in a prolonged stay in hospital, and may lead to fluid, electrolyte, protein, and immune disturbances. Healing can also be impaired. We describe a case where an excessive chylous leak also contributed to the failure of two free flaps in the same patient, and we make recommendations regarding management of patients with free tissue transfer where this complication arises.
Management of Chyle Leak in the Neck Following Thyroid Cancer Surgery: A Single Center Experience
World Journal of Endocrine Surgery, 2015
Introduction: Surgery for thyroid cancers often necessitates a neck dissection. This is usually a safe procedure, but can be associated with complications. Chyle leak is one such complication, fortunately rare. There is a dearth of literature with regard to the management of chyle leak in the neck. We present a single center experience in the management of chyle leak in the neck, to improve the understanding of its management.
Chyle leakage in port incision after video-assisted thoracoscopic surgery: case report
Journal of Cardiothoracic Surgery, 2010
A 26-year-old Asian male was found to have chyle leakage from the port incision after video-assisted thoracoscopic surgery (VATS) for excision of pulmonary bullae. The diagnosis was confirmed by oral intake of Sudan black and by lymphoscintigraphy. The leakage resolved after 5 days of restricted oral intake and total parenteral nutrition. No leakage recurred after return of oral intake. Possible explanations for the port incision chyle leakage are obstruction of the thoracic duct, which induced retrograde drainage of the lymphoid fluid, or an aberrant collateral branch of the thoracic duct in the chest wall.
Scandinavian Journal of Surgery, 2021
Background: Thoracic duct chylous fistula is a rare complication following neck surgery, especially for malignant disease. Despite its low incidence, it can be a life-threatening postoperative complication increasing the risk of infection, bleeding, hypovolemia, electrolyte imbalance, and malnutrition. Currently, the management of thoracic duct fistula is not standardized yet. It can range from conservative to surgical approaches, and even when surgery indication occurs, there is no unanimous agreement on timing and operative steps, so the surgical approach still remains mostly subjective, in accordance with clinical conditions of the patients and with surgeon’s experience. Aims: The aim of the study was to search into Literature a common accepted behaviour in thoracic duct chylous fistula occurring. Methods: A literature review was carried out. Conservative treatments include fasting associated with total parental nutrition or low-fat diet, compressive dressings, and octreotide adm...
Thoracic duct embolization: a new treatment for massive leak after neck dissection
The Laryngoscope, 2008
Chylothorax results from injury to the thoracic duct or one of its branches. It is an uncommon but possibly serious complication of thoracic or head and neck surgery. We report a case of thoracic duct transection complicating a total laryngectomy with bilateral selective neck dissection for subglottic squamous cell carcinoma. High-output Jackson Pratt drainage was noted, resulting in patient hypovolemia that was unresponsive to volume resuscitation. Treatment consisted of percutaneous embolization of the thoracic duct proximal to the transection that subsequently normalized chylous output.
Thoracoscopic ligation of the thoracic duct
Surgical Endoscopy, 1993
Objective: When nonoperative treatment of chylothorax fails, thoracic duct ligation is usually performed through a thoracotomy. We describe two cases of persistent chylothorax, in a child and an adult, successfully treated with thoracoscopic ligation of the thoracic duct.
Head & Neck, 2007
Background. Chylous fistula occurring after head and neck or thoracic surgery is an uncommon but well-described complication, with a reported incidence of 1% to 2.5%. Conservative management can be successful and consists of dietary measures combined with suction drainage. This article reports on percutaneous embolization of the thoracic duct through catheterization of the retroperitoneal lymph vessels. Methods. Two patients, in whom conservative management for cervical chylous fistula failed, underwent lymphangiography with opacification of the thoracic duct, followed by radioguided catheterization and embolization. Results. Embolization was successful in both patients. In 1 patient the procedure had to be repeated once to stop the chylous drainage. Conclusions. Radioguided percutaneous catheterization and embolization of the retroperitoneal lymph vessels offers an excellent treatment option for patients with persistent chylous fistulas after failure of conservative management. We revised our stepwise management protocol (de Gier, Head Neck 1996; 18:347-351) and now consider this procedure as the secondary intervention step. V V