Uniportal video-assisted thoracoscopic surgery right thoracic duct ligation for chyle leak following right supraclavicular lymph node biopsy: a case report

Abstract

: Chyle leak is a rare but known complication following head and neck surgery, especially after resection of tumour in the base of the neck. The diagnosis of chyle leak can be made by demonstrating milky drainage, fluid analysis for chyle (triglyceride level >110 mg/dL, lymphocyte count >90% of total white blood cell count or total protein content similar to plasma) as well as lymphangiogram to identify the leak point. Low output chyle leak (<500 mL/day) is usually managed successfully by non-surgical approach which consist of dietary modification (fat intake <10 g/day), pharmacological treatment (subcutaneous octreotide injection 0.1 mg every 8 hours for 3 to 5 days) and drainage. However, if conservative measures fail or in high output chyle leak, surgical intervention is indicated. Thoracic duct ligation by uniportal video-assisted thoracoscopic surgery (VATS) is rarely described in the literature. In this case report, we describe a patient with chyle leak after right supraclavicular lymph node biopsy whom failed non-surgical management and underwent right uniportal VATS thoracic duct ligation, without dividing the duct. The patient made uneventful recovery with complete resolution of chyle leak. Uniportal VATS ligation of thoracic duct for chyle leak can be considered as the primary approach for surgical treatment.