Management of thoracic duct injuries after oesophagectomy

• Published in: British journal of surgery Vol. 88; no. 11; pp. 1442 - 1448
• Main Authors: Wemyss-Holden, S. A., Launois, B., Maddern, G. J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.11.2001; Wiley
• Subjects: Animals; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Clinical Protocols; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Dogs; Esophagectomy - adverse effects; Esophagus; Humans; Medical sciences; Postoperative Care - methods; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thoracic Duct - injuries; Thoracic Duct - surgery; Human; Laceration; Iatrogenic; Pathophysiology; Esophagectomy; Cardiovascular disease; Anatomy; Trauma; Mechanism; Lymphatic vessel disease; Esophagus; Symptomatology; Treatment; Surgery; Thoracic duct; Complication; Clinical investigation; Physiology; Therapeutic protocol; Bibliographic review
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1046/j.0007-1323.2001.01896.x

Background: Thoracic duct laceration is a rare but potentially life‐threatening complication of oesophagectomy. The management of such an injury is uncertain in respect of the relative merits of conservative and surgical treatment. Methods: The literature was reviewed by searching Medline databases from 1966 to the present time. The majority of the evidence presented is level 3, as no randomized or controlled data are available. Results: Prolonged conservative treatment of thoracic duct injury is associated with a mortality rate of 50–82 per cent. The results of early surgical ligation of the duct are more encouraging, with a mortality rate of 10–16 per cent. Elective ligation of the duct reduces the incidence of postoperative chylothorax. Conclusion: The thoracic duct should be ligated during oesophagectomy. A high index of suspicion for duct injury must be maintained in all patients after operation. A policy of very early thoracic duct ligation at 48 h from diagnosis is proposed for duct injury if aggressive conservative management fails. © 2001 British Journal of Surgery Society Ltd