Thoracic Duct Leak - Forum

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Sweden surgeon

Thoracic Duct Leak - Ärzteforum

Post#1 »

My partner had an interesting complication and is seeking some advice.

She operated upon a 50 yo male with a large substernal goiterous thyroid. Operation (total thyroid) went well with parathyroids and bilateral recurrent laryngeal neves identified and preserved. Becaused of the large cavity left behind by the goiterous mass, she left a jackson pratt drain behind. The drain has been putting out approximately 120 - 150 cc of chylous material daily since surgery almost two weeks ago. Laboratory analysis of material consistent with chyle. Patient has been on low fat diet with no change in drain output.

Does anyone have any suggestions regarding management of this complication?

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A Doctor

Re: Thoracic Duct Leak - Ärzteforum

Post#2 »

Re-explore, suture ligate the injured large lymphatic channel (after the generous meal of cream)- before the patients losses all his proteins and lymphocytes.


Re: Thoracic Duct Leak - Ärzteforum

Post#3 »

Try keeping the patient nil per mouth for a few days and watch your drainage. This should help in about 70% of cases.


Re: Thoracic Duct Leak - Ärzteforum

Post#4 »

I had had similar complication 2 cases . No any of them required other measures more than to expect . take into account that the skin wil lbe redish and cellular tissue swelling but that is not infection . I do not suggest ligation of the thoracic duct because the amount of drainage is not high . wait and see .

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Re: Thoracic Duct Leak - Ärzteforum

Post#5 »

The best way to fix this is to reoperate, give the patient heavy cream prior to operation, as it will opacify the lymph fluid coming from thew severed or injured thoracic duct.

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Re: Thoracic Duct Leak - Ärzteforum

Post#6 »

The best way to manage this complication is to discover it during the initial surgery,as it is very simple to detect and to fix by legating the injured duct. It is well known that dissection of the left lower part of the neck,for any reason,may be complicated by this type of injury and you should leave this area completely dry from blood and any clear fluid ooze.

If the amount of discharging fluid is not considerably reduced this patient will need another exploration.


Re: Thoracic Duct Leak - Ärzteforum

Post#7 »

Would be very important for me to know, what type of difficulties found especially that it already does not goes to be immediate or precocious . In case that is indicated and not find the source ( I suppose so due to time lasted ) would be necessary the ligature of the thoracic duct by way of right thoracic access ( conventional or thoracoscopy ) . Sometimes yet durin the initial surgery is hard halt limphorrage given that at times small limphatic vesel tear up when one is tryin to suture it . A resource that I have employee with good result is suturing a patch of fat ( extracted from the subcutaneous tissue ) against the site of limphorrage .


Re: Thoracic Duct Leak - Ärzteforum

Post#8 »

I do agree, as we have had such complication in left pneumonectomy, but surgery was only required when there was an excessive drainage over 3-4 days despite no fat diet. We have used total parenteral nutrition in some cases, but not with such a small amount of fluid over 24 hour period. It will probably be very difficult to reexplore and ligate the lymphatic duct in the neck region; whenever we had to use surgery in these cases, right thoracoscopic approach, or open surgery is the best.


Re: Thoracic Duct Leak - Ärzteforum

Post#9 »

For this rare complication,I would prefer:

If the leak is 100-150 ml/day or less:
Remove the drain
Nil per os,TPN for a few days
Patient stays in bed,because "any activyties of the lower extremities increses the flow of the limph"
I am sure that reop. is not easy for to recognice and ligate the thoracic duct in the neck.


Re: Thoracic Duct Leak - Ärzteforum

Post#10 »

Recently I saw a case in my hospital. It was a patient with a stab wound in the left subclavicular area. Finally the leakage stop after a right videotorascopy and clip ligation of the thoracic duct.

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