Therapeutic strategy for chylous leakage after esophagectomy: focusing on lymphangiography using lipiodol

Lymphatic Interventional Radiology for Postoperative Lymphatic Leakage

“…Conventional pedal lymphangiography is a technically complicated procedure, requiring dorsum pedis skin incisions, and pedal lymphatic vessel isolation and direct cannulation, which has prohibited its widespread use. 4,5 Currently, intranodal lymphangiography is preferred as the diagnostic tool in patients with abdominal or thoracic lymphatic leakage. However, inguinal or femoral lymph node intranodal lymphangiography may not be appropriate in patients with inguinal lymphatic leakage.…”

“…Conventional pedal lymphangiography is a technically complicated procedure, requiring dorsum pedis skin incisions, and pedal lymphatic vessel isolation and direct cannulation, which has prohibited its widespread use. 4 5…”

“…Lymphangiography is performed as a diagnostic tool for identifying a leak point in chylothorax and chylous ascites, but the amount of lymphatic leakage could be decreased in some cases. 4 6 7 Two possible mechanisms of lipiodol action have been discussed. One is that lipiodol that leaks through the damaged point of the lymphatic vessel causes an inflammatory response that blocks the lymphatic vessel.…”

“…3 More invasive treatments, such as thoracic duct ligation or clipping, are attempted when patients suffer from postoperative lymphatic leakage that is refractory to more conservative treatments. 4 However, surgical management may be difficult due to postoperative adhesion and poor nutritional condition. 3…”