Treatment Of Chyle Leak Research Articles

Large Variation in Diagnosis and Treatment of Chyle Leak after Pancreatic Surgery: A Nationwide Insight

Background: In the current literature different diagnosis and treatment strategies for chyle leak after pancreatic surgery are described. In 2017, the International Study Group for Pancreatic Surgery defined a consensus-based definition for diagnosis. However, consensus on the optimal treatment strategy is lacking. Aim: The aim of this multicenter study is to investigate the current treatment and diagnosis of chyle leak after pancreatic surgery in clinical practice in the Netherlands to gain insight into practical applications of chyle leak. Methods: A nationwide survey about the diagnosis and treatment of chyle leak was sent to specialized dieticians and pancreatic surgeons from all 16 pancreatic centers collaborating in the Dutch Pancreatic Cancer Group. Data was quantitative processed according to thematic content analysis and by using descriptive analysis. Results: In total, 16 dieticians from 16 centers and 20 surgeons from 12 centers completed the questionnaire. Analysis showed that the International Study Group for Pancreatic Surgery-definition for chyle leak was used in clinical practice by 31% (n=11) of the respondents. The results show also large nationwide variation in treatment of chyle leak after pancreatic surgery, as well between as within centers. The most common treatment was a step-up approach of nutritional therapies (44% (n=16)), which starts with an enteral fat restricted diet enriched with medium chain fatty acids followed by total parenteral nutrition. Conclusion This study shows that the current diagnosis and treatment strategies for chyle leak after pancreatic surgery in clinical practice on a nationwide scale are different. More comparable studies are needed to define the optimal treatment strategy for chyle leak. There is need for an international multidisciplinary (sub)working group to reach consensus on the treatment strategy of chyle leak and to discuss implementation strategies for clinical practice.

Treatment of chyle leak after pancreatic surgery: consensus and research needed!

Rationale: Consensus is lacking on the optimal management strategy for chyle leak (CL) after pancreatic surgery. The aim of this multicenter study is to investigate the current treatment of CL in the Netherlands.

Vascular and lymphatic complications after thoracic duct cannulation

ObjectiveThe objective of this study was to determine the incidence of vascular and lymphatic complications after attempted transabdominal thoracic duct cannulation. MethodsThere were 58 patients who underwent attempted thoracic duct cannulation. Patients presented with chyle leak in the chest (n = 40), abdomen (n = 9), neck (n = 8), and pelvis (n = 1). Vertebral body level and geographic access, needle gauge, additional access for treatment, technical success, intervention performed, immediate and delayed complications, and follow-up duration were recorded. Imaging and electronic medical records were reviewed at follow-up for complications and treatment success. ResultsAccess into the lymphatic system was obtained at L1 (n = 21), T12 (n = 17), L2 (n = 14), L3 (n = 3), T11 (n = 1), L4 (n = 1), and L5 (n = 1). Lymphatic access was achieved in the center (n = 28), on the right (n = 16), or on the left (n = 14) of the vertebral body; 21-, 22-, and 25-gauge needles were used in 45 patients, 12 patients, and 1 patient, respectively. Arm venous and percutaneous supraclavicular access was successful in 15 patients and eight patients, respectively. Cannulation of the thoracic duct was achieved in 52 (89.7%) patients. Embolization, disruption, and stenting were performed in 41 (70.7%), 12 (20.7%), and 2 (3.4%) patients; 3 (5.2%) patients had normal thoracic ducts after successful cannulation. Immediate complications consisted of shearing of the access wire in two (3.4%) patients. Retrospective analysis of initial follow-up imaging in 49 (84.5%) patients revealed the following late complications: inferior vena cava and right renal vein thrombosis and one perinephric lymphatic collection. ConclusionsOf 58 patients who had attempted thoracic duct cannulation, successful access was achieved in 90% of patients. Early and delayed complications occurred in 3.4% and 4% of patients, respectively. Thoracic duct cannulation represents a highly successful technique that aids in the treatment of chyle leaks in medically complex patients.

Treatment of Chyle Leak by Percutaneous Alcohol Sclerosis of the Cisterna Chyli: A Case Report

Treatment of Chyle Leak by Percutaneous Alcohol Sclerosis of the Cisterna Chyli: A Case Report

Should TP3 form part of the surgical algorithm for treatment of chyle leaks in the neck?

Should TP3 form part of the surgical algorithm for treatment of chyle leaks in the neck?

Successful Conservative Treatment of Chyle Leak after Total Thyroidectomy and Modified Radical Lymph Node Dissection

Successful Conservative Treatment of Chyle Leak after Total Thyroidectomy and Modified Radical Lymph Node Dissection

Blood patch treatment of chylothorax following transthoracic oesophagogastrectomy: a novel technique to aid surgical management

Chylothorax is a well-recognised complication of oesophagectomy, occurring in around 3% of cases. If managed conservatively, the mortality rate can be over 50%. We describe our experience of managing a patient with a chylothorax following oesophagectomy, and the use of a blood patch (a novel technique) to overcome persistent leakage following re-operation. The authors feel that this technique has the potential for a wider application in the treatment of chyle leak, especially if combined with minimally invasive or radiological techniques.