Use of N-butyl-2-cyanoacrylate tissue glue in thoracic duct injury during neck dissection surgery

ABSTRACT 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 pertinent 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 recog- nized 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. How to cite this article Cherian a, Ramakant P, Paul MJ, Abraham DT. Management of Chyle Leak in the Neck Following Thyroid Cancer Surgery: A Single Center Experience. World J Endoc Surg 2015;7(1):6-9.

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Single port thoracoscopic treatment of thoracic duct injury after thyroidectomy with neck dissection

ASVIDE ◽

10.21037/asvide.2017.451 ◽

2017 ◽

Vol 4 ◽

pp. 451-451

Author(s):

Serkan Teksoz ◽

Ezel Ersen ◽

Akif Enes Arikan ◽

Sina Ferahman ◽

Kamil Kaynak ◽

...

Keyword(s):

Neck Dissection ◽

Thoracic Duct ◽

Single Port ◽

Thoracic Duct Injury

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A rare case of abnormally high thoracic duct in neck

International Surgery Journal ◽

10.18203/2349-2902.isj20212750 ◽

2021 ◽

Vol 8 (7) ◽

pp. 2247

Author(s):

Amol Padegaonkar ◽

Anushree Sehgal ◽

Shambhunath Agrawal

Keyword(s):

Squamous Cell Carcinoma ◽

Neck Dissection ◽

Buccal Mucosa ◽

Thoracic Duct ◽

Rare Case ◽

Valsalva Manoeuvre ◽

Significant Morbidity ◽

Chyle Leak ◽

Thoracic Duct Injury ◽

Omohyoid Muscle

Thoracic duct injury can be a cause of significant morbidity if its injury remain undiagnosed during surgery. Knowledge of its course and anomaly should be known to prevent its injury. Presenting a case of 40 year male who was diagnosed to have left buccal mucosa squamous cell carcinoma. During neck dissection, anomalous thoracic duct was found much above the omohyoid muscle. Adequate steps were taken to prevent injury to it. It is necessary to acknowledge thoracic duct and prevent its injury during neck dissection. Knowledge about its anomalous path should be known to prevent its injury. Valsalva manoeuvre should be done at the end of neck dissection to find and thoracic duct injury by observing chyle leak and adequate measures should be taken immediately to prevent morbidity associated with it.

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Viscum album extract (Helixor-M) treatment for thoracic duct injury after modified radical neck dissection: a case report

Gland Surgery ◽

10.21037/gs-20-629 ◽

2021 ◽

Vol 10 (2) ◽

pp. 832-836

Author(s):

Chai-Won Kim ◽

Jeong-Soo Kim ◽

Ae-Hee Lee ◽

Yong-Seok Kim

Keyword(s):

Case Report ◽

Neck Dissection ◽

Thoracic Duct ◽

Radical Neck Dissection ◽

Viscum Album ◽

Modified Radical Neck Dissection ◽

Thoracic Duct Injury

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Single port thoracoscopic treatment of thoracic duct injury after thyroidectomy with neck dissection

Gland Surgery ◽

10.21037/gs.2017.07.14 ◽

2017 ◽

Vol 6 (5) ◽

pp. 598-601 ◽

Cited By ~ 1

Author(s):

Serkan Teksoz ◽

Ezel Ersen ◽

Akif Enes Arikan ◽

Sina Ferahman ◽

Kamil Kaynak ◽

...

Keyword(s):

Neck Dissection ◽

Thoracic Duct ◽

Single Port ◽

Thoracic Duct Injury

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Thoracic duct injury after decortication of lung, new technique to repair thoracic duct in this challenging situation: A case report

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492321997080 ◽

2021 ◽

pp. 021849232199708

Author(s):

Nandkishore Kapadia ◽

Saumya Sekhar Jenasamant ◽

Ganesh Sohan Singh Rawat ◽

Shailesh Kamkhedkar ◽

Pratik Shah ◽

...

Keyword(s):

Thoracic Duct ◽

Left Lung ◽

Lower Lobe ◽

Late Complications ◽

Patch Repair ◽

Double Lumen Tube ◽

Complex Case ◽

Thoracic Duct Injury ◽

Thoracic Duct Ligation ◽

Duct Ligation

Background Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Very few patients respond to conservative line of therapy. Thoracic duct ligation is often the treatment of choice in post-surgical patients; however, the optimal treatment of this disease process after traumatic injury remains unclear. Case presentation: We present the case of a 46-year-old woman with thoracic duct injury secondary to decortication for post-pneumonic empyema. Conservative therapy and pleurodesis done twice failed. She developed severe cachexia losing 15 kg in 30 days. She was referred to our center for ligation of thoracic duct. Preoperative lymphangiography located the duct injury in upper part of mediastinum. Computerized tomography scan of chest showed collapse of left lower lobe and thickened left pleura, indicating a significant pericardial effusion. She underwent decortication of left lung, pericardial window, and native pericardial patch repair of thoracic duct. Results and Conclusions: In this unusual and complex case, successful resolution of the chyle leak was achieved with new surgical technique of patch repair. The patient recovered well and was now on a normal diet. She has put on 12 kg in four months. We have avoided late complications of thoracic duct ligation by this technique. This nouvelle technique may be recommended as it is simple and effective. Ligation of thoracic duct carries late complications. Isolating right lung by double lumen tube may cause severe hypoxia as left-sided lung is not expanded as in this case.

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Thoracic Duct Embolization: A New Treatment for Massive Leak After Neck Dissection

The Laryngoscope ◽

10.1097/mlg.0b013e31816067b8 ◽

2008 ◽

Vol 118 (4) ◽

pp. 680-683 ◽

Cited By ~ 22

Author(s):

Neel Patel ◽

Robert J. Lewandowski ◽

Michiel Bove ◽

Albert A. Nemcek ◽

Riad Salem

Keyword(s):

Neck Dissection ◽

Thoracic Duct ◽

New Treatment

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Post-thyroidectomy hypocalcemia exacerbated by chyle leak

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-14-0110 ◽

2015 ◽

Vol 2015 ◽

Author(s):

Naweed Alzaman ◽

Anastassios G Pittas ◽

Miriam O'Leary ◽

Lisa Ceglia

Keyword(s):

Total Thyroidectomy ◽

Thoracic Duct ◽

Treatment Options ◽

Oral Intake ◽

Neck Surgery ◽

List Type ◽

Chyle Leak ◽

Thoracic Duct Injury ◽

Extensive Lymph Node ◽

Learning Points

Summary Transient hypocalcemia after thyroidectomy is not uncommon and the risk increases with the extent of neck surgery. We report a case of severe and prolonged hypocalcemia after total thyroidectomy complicated by thoracic duct injury. Hypoparathyroidism and thoracic duct injury are potential complications following total thyroidectomy with extensive lymph node dissection. This case suggested that having both conditions may complicate treatment of hypoparathyroid-induced hypocalcemia by way of losses of calcium and vitamin D in the chyle leak. Learning points This report highlights chyle leak as an uncommon cause of prolonged hypocalcemia in patients who have undergone extensive neck surgery. Chyle has an electrolyte concentration similar to that of plasma. Medical treatment options for a chyle leak include fat-free oral diet or parenteral nutrition without oral intake, pharmacological treatment (primarily octreotide).

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