scholarly journals Prolonged iatrogenic thoracic duct chylous fistula in Neck Surgery: conservative management or surgery? A Literature review

2021 ◽  
pp. 145749692098707
Author(s):  
D. Parmeggiani ◽  
G. Gualtieri ◽  
G. Terracciano ◽  
C. Gambardella ◽  
S. Parisi ◽  
...  
Keyword(s):  
Literature Review ◽  
Thoracic Duct ◽  
Rare Complication ◽  
Neck Surgery ◽  
Electrolyte Imbalance ◽  
Surgical Approaches ◽  
Low Fat Diet ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Chylous Fistula

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 administration. If conservative treatment fails, in order to avoid dangerous consequences, functional repair of the thoracic duct injury with lymphovenous microanastomosis should be the preferred solution, rather than an approach that obliterates the thoracic duct or lymphatic–chylous pathways, such as thoracic duct embolization, therapeutic lymphangiography, and thoracic duct ligation. Conclusions: In our experience, patients undergone thyroidectomy and neck dissection for thyroid-differentiated cancer, who report an unrecognized thoracic duct chylous fistula after surgery, must be treated via integrated conservative and surgical treatment. A literature review about thoracic duct chylous fistula following neck surgery, focusing on the current management and therapeutic approach, was furthermore carried out, in order to delineate the actual therapeutic options in case of thoracic duct chylous fistula occurrence.

scholarly journals Case Report: Management of idiopathic chylothorax

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 1049 ◽  
Author(s):  
Maher Abouda ◽  
Yangui Ferdaous ◽  
Miriam Triki ◽  
Mehdi Charfi ◽  
Mohamed Ridha Charfi
Keyword(s):  
Case Report ◽  
Pleural Fluid ◽  
Medical Therapy ◽  
Thoracic Duct ◽  
Medium Chain Triglyceride ◽  
Pleural Space ◽  
Low Fat Diet ◽  
Thoracic Duct Ligation ◽  
Bilateral Chylothorax ◽  
Duct Ligation

Chylothorax is characterized by the presence of chyle in the pleural space and results from lesion or obstruction of the thoracic duct. We present two cases of non-traumatic, idiopathic chylothorax in two females that were treated differently. The first is a 42 year old female who presented with a symptomatic right chylothorax. Treatment by a low-fat diet supplemented with medium chain triglyceride and evacuation of the pleural fluid was sufficient. The second patient is a 25 year old female admitted for a bilateral chylothorax. Despite optimal medical therapy, chylothorax continued to persist. Finally thoracic duct ligation was performed, which resulted in resolution of the effusion. These two cases illustrate that the management of idiopathic chylothorax can be surgical or nonsurgical.

scholarly journals Management and overview of postoperative chylothorax after congenital cardiothoracic surgery

2019 ◽  
Vol 7 (1) ◽  
pp. 107
Author(s):  
Dhananjay Bansal ◽  
Vaibhav Chugh ◽  
Rahul Bhushan ◽  
Javed M. Banday ◽  
Narender S. Jhajhria ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Cardiothoracic Surgery ◽  
Variable Effect ◽  
Low Fat Diet ◽  
Cardiac Procedures ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Cavopulmonary Anastomosis ◽  
Duration Of Hospitalization ◽  
The Impact

Background: The aim of the study was to determine the incidence, risk factors, and outcomes for chylothorax in patients undergoing cardiothoracic surgery, with special emphasis on its management.Methods: Total of 24 patients with post-operative chylothorax, operated from September 2015 to December 2018, was included in the study. Medical records were maintained, including daily records of drainage volumes and management.Results: From September 2015 to December 2018, there were 24 cases of chylothorax in 600 congenital cardio-thoracic surgeries-an incidence of 4.0%. Overall mortality rate was similar, but cases had longer postoperative hospital stays (median, 22 versus 8 days). Incidence of chylothorax was significantly higher with congenital cardiac procedures. Diagnosis was made at a median of 6 days after surgery. Duration of drainage was a median of 15 days, with 11 patients draining more than 30 days. Longer duration of drainage was associated with cavopulmonary anastomosis procedure. Nutritional management included low fat diet, enteral feeds enriched with medium-chain triglycerides, and parenteral nutrition. Three patients were treated with octreotide, 4 with thoracic duct ligation, and 1 with pleurodesis. Octreotide was associated with a variable effect on drainage. Thoracic duct ligation reduced, but did not stop drainage.Conclusions: Chylothorax increases duration of hospitalization after cardiovascular surgery in children. Early diagnosis may reduce the duration of chylothorax. Nutritional strategies remain the cornerstone for management of postoperative chylothorax. The impact of octreotide and surgical intervention is limited when reserved for patients with severe or prolonged drainage.

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

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.

665 PROPHYLACTIC THORACIC DUCT OBSTRUCTION DURING ESOPHAGECTOMY: THE IMPACT ON PERIOPERATIVE RISKS AND LONG-TERM SURVIVAL. A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Clara Santos ◽  
Laura Santos ◽  
Leticia Datrino ◽  
Guilherme Tavares ◽  
Luca Tristão ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Thoracic Duct ◽  
Meta Analysis ◽  
Term Survival ◽  
Long Term Survival ◽  
Thoracic Duct Ligation ◽  
Duct Ligation

Abstract   During esophagectomy for cancer, there is no consensus if prophylactic thoracic duct ligation (TDL), with or without thoracic duct resection (TDR), could influence the perioperative outcomes and long-term survival. This systematic review and meta-analysis compared patients who went through esophagectomy associated or not to ligation or resection of the thoracic duct. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central and Lilacs (BVS). The inclusion criteria were: (1) studies that compare thoracic duct ligation, with or without resection, and non-thoracic duct ligation; (2) involve adult patients with esophageal cancer; (3) articles that analyses the outcomes—perioperative complications, perioperative mortality, chylothorax development and overall survival; (4) only clinical trials and cohort were accepted. A 95% confidence interval (CI) was used, and random-effects model was performed. Results Fifteen articles were selected, comprising 6,249 patients. TDL did not reduce the risk for chylothorax (Risk difference [RD]: -0.01; 95%CI: −0.02, 0.00). Also, TDL did not influence the risk for complications (RD: -0.02; 95%CI: −0.11, 0.07); mortality (RD: 0.00; 95%CI: −0.00, 0.00); and reoperation rate (RD: -0.01; 95%CI: −0.02, 0.00). TDR was associated with higher risk for postoperative complications (RD: 0.1; 95%CI 0.00, 0.19); chylothorax (RD: 0.02; 95%CI 0.00, 0.03). Both TDL and TDR did not influence the overall survival rate (TDL: HR: 1.17; 95%CI: 0.86, 1.48; and TDR: HR: 1.16; 95%CI: 0.8, 1.51). Conclusion Thoracic duct obliteration with or without its resection during esophagectomy does not change long term survival. Nonetheless, TDR increased the risk for postoperative complications and chylothorax.

scholarly journals Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

2020 ◽  
Vol 8 (2) ◽  
pp. 767
Author(s):  
Oluwaseun R. Akanbi ◽  
Swaminathan Vaidyanathan ◽  
Prakash Agarwal ◽  
Janeel Musthafa ◽  
Neville A. G. Solomon
Keyword(s):  
Thoracic Duct ◽  
Medium Chain Triglyceride ◽  
Cystic Lymphangioma ◽  
Satisfactory Outcome ◽  
Thoracic Duct Ligation ◽  
Risk Of Mortality ◽  
Duct Ligation ◽  
Surgical Options ◽  
Polytetrafluoroethylene Patch ◽  
Substantial Morbidity

Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first employed in managing this. Surgical options are adopted when the effusion is protracted, most recent of which includes diaphragmatic fenestration. A 9-year-old girl is presented who developed recurrent right chylothorax following thoracoscopic excision of a cystic lymphangioma. Following failed conservative therapy, she had thoracic duct ligation and right diaphragmatic fenestration (using fenestrated polytetrafluoroethylene patch) with satisfactory outcome. Aetio-pathologic mechanisms implicated in postoperative chylothorax have been classified into traumatic (iatrogenic injury to the thoracic duct or its branches) and non-traumatic. With initial conservative measures (repeated pleural aspirations and intercostal drainage, medium chain triglyceride/ low fat feeds or alternatively, fasting and total parenteral nutrition) spontaneous closure remains unpredictable. Diaphragmatic fenestration when employed resulted in faster resolution of effusion and earlier commencement of enteral feeding with no significant complication. Diaphragmatic fenestration is effective and safe for treating refractory post-operative chylothorax.

Uniportal video-assisted thoracoscopic surgery right thoracic duct ligation

ASVIDE ◽  
2021 ◽  
Vol 8 ◽  
pp. 056-056
Author(s):  
Pei Fern Koh ◽  
Narasimman Sathiamurthy ◽  
Nguk Chai Diong ◽  
Benedict Dharmaraj
Keyword(s):  
Thoracic Duct ◽  
Thoracoscopic Surgery ◽  
Video Assisted ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Video Assisted Thoracoscopic Surgery

Laparoscopic Transhiatal Thoracic Duct Ligation for Chylothorax after Esophagectomy

2019 ◽  
Vol 67 (07) ◽  
pp. 606-609 ◽  
Author(s):  
Yukinori Yamagata ◽  
Kazuyuki Saito ◽  
Kosuke Hirano ◽  
Masatoshi Oya
Keyword(s):  
Esophageal Cancer ◽  
Conservative Treatment ◽  
Thoracic Duct ◽  
Thoracic Cavity ◽  
Transthoracic Approach ◽  
Thoracic Esophageal Cancer ◽  
Transhiatal Approach ◽  
Thoracic Duct Ligation ◽  
Duct Ligation ◽  
Laparoscopic Transhiatal Approach

AbstractIn esophagectomy for thoracic esophageal cancer, chylothorax may develop at a certain frequency. For chylothorax, conservative treatment is selected first, but if it is not improved, thoracic duct (TD) ligation is considered. In general, transthoracic approach is chosen to reach the TD. However, it is sometimes difficult to identify the TD due to adhesion in the thoracic cavity. Hence, we selected a laparoscopic transhiatal approach to the TD. We introduce the procedure of our laparoscopic transhiatal TD ligation technique.

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