Modern Management of Chylous Leak Following Head and Neck Surgery: A Discussion of Percutaneous Lymphangiography-Guided Cannulation and Embolization of the Thoracic Duct

Scorza, Leslie B.; Goldstein, Bradley J.; Mahraj, Rickhesvar

doi:10.1016/j.otc.2008.06.004

Cited by 44 publications

(28 citation statements)

References 15 publications

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“…The percutaneous technique has been previously described in detail [7,19]. To summarize, the procedure starts with a radiologic demonstration of the cisterna chyli via pedal lymphography, followed by percutaneous, transperitoneal access to the cisterna using a modified Seldinger technique.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of thoracic duct injuries

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of thoracic duct injuries

et al. 2011

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“…5 There have been reports of chyle leak from the right side, up to 25% being reported. [6][7][8] This is due to injury to the right lymphatic duct. Our experience was similar with right sided chyle leak in six out of 25 patients (24%).…”

Section: Left Vs Rightmentioning

confidence: 99%

“…2,8 The damaged thoracic duct may be visualized, embolization coils and tissue adhesive may be placed. This is a time consuming procedure requiring multiple attempts, specialized personnel and equipment.…”

Section: Newer Modalities Of Managementmentioning

confidence: 99%

Management of Chyle Leak in the Neck Following Thyroid Cancer Surgery: A Single Center Experience

Abraham¹,

Cherian²,

Paul³

2015

World Journal of Endocrine Surgery

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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. Materials and methods:A retrospective analysis of patients with thyroid cancer, managed between January 1st 2005 and December 31st 2011, in a single institution was performed. Among these, patients with chyle leak were identified. All perti nent data collected and results analyzed using STATA (v10). Results:Three hundred and seventy-three/eight hundred and twenty-one (45.4%) patients surgically managed for thyroid cancer underwent a neck dissection. Thoracic duct injury was recognized and managed intraoperatively in 20/373 (5.4%) patients. The leak was prevented in the majority (66.6%) of patients in whom a combination of methods were employed. 25/373 (6.7%) patients were diagnosed and managed for chyle leak postoperatively. Seven patients required re-exploration. This included patients with low output chyle leaks who may have settled in a week to 10 days with conservative management. A combination of techniques was successful in the majority (71.4%). The remaining patients were successfully managed conservatively. Conclusion:We conclude that using a combination of methods to manage thoracic duct injury may be better than using a single modality alone. Early re-exploration was more economical and acceptable for a subset of our patients, as they come from long distances at personal cost.

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“…A chyle fistula is an exudation of chyle following the rupture of lymph vessels. It is a complication of major neck surgery in 1-3% of patients [3] and approximately 75% occur on the left side, while 25% occur on the right [1]. The flow of chyle is approximately 2-4 L per day, although chyle production is dependent upon diet and daily intake, increasing with fatty meals.…”

mentioning

confidence: 99%

“…A replacement with total parenteral nutrition is made if the fistula persists [5]. Percutaneous embolization of the thoracic duct can also be attempted [1].Authors have recommended re-operation in selective cases when the chyle fistula does not resolve upon conservative treatment of persistent low output fistulas, high output fistulas treated medically for one week, or when complications arise. There are currently no clear standards to indicate the exact time for re-operation if the patient does not meet one of the above criteria [13].…”

mentioning

confidence: 99%