Objectives: To document the treatment of refractory chyle leaks using thoracoscopic thoracic duct ligation and provide systematic guidelines to manage chyle leaks. Methods: The medical records of 2 patients with chyle leaks are reviewed, followed by a review of the literature on chyle leaks and their thoracoscopic management. Conclusions: Initial treatment of chyle fistula is aimed at conservative medical management. Persistent high-output fistulas (>500 cm3) should be considered for neck reexploration as conservative management is likely to fail. Thoracoscopic thoracic duct ligation provides a safe and efficient means of treating chyle leaks refractory to repeated surgical and medical intervention. It should also be considered as a primary surgical intervention for patients with: (1) chyle output exceeding 500 cm3/day where prior intraoperative attempts at ligation have failed, (2) severe metabolic and nutritional complications, (3) coexisting chylothorax with respiratory compromise, and (4) low-output fistulas (<500 cm3/day) of long duration (>14 days).

Keywords:
Chyle leak, Chylothorax, Thoracoscopic ligation, Thoracic duct
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© 2004 S. Karger AG, Basel
2004
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