The Effective Treatment of Postoperative Chyle Leaks with Interventional Radiology Assistance

INTRODUCTION: Lymph-angioembolization (LGE) has become an alternative to surgical duct ligation (SDL) for treatment of postoperative lymphatic leaks (PLL). There are limited studies investigating the use of SDL vs LGE for PLL treatment. METHODS: This retrospective review studied PLL patients who underwent index surgery or interventional radiology (IR) procedure at a single tertiary-care center over a ten-year span. Patient demographics, operative details, IR procedure details, and patient outcomes were analyzed. The primary outcome was clinical resolution of PLL. Descriptive statistics are reported as median (interquartile range [IQR]) for continuous variables and number (%) for categorical variables. RESULTS: Twenty-four patients were included, with most undergoing cardiothoracic surgery (17/24, 70.8%). The most common operative approach was open (13/24, 54.2%) and most index operations included lymph node dissection (15/24, 62.5%). Median length of time from PLL diagnosis to initial IR procedure was 10 (5−13) days. Four SDLs occurred, with an overall success rate of 25% (1/4), three patients who failed SDL successfully underwent LGE. Twenty-one (87.5%) patients underwent an IR procedure for treatment of PLL, with an 81% initial success rate (17/21). Four patients underwent a second IR procedure, with a 100% success rate (4/4). CONCLUSION: PLL is uncommon and can be safely treated with IR interventions. The standard of care for PLL includes SDL, which requires an invasive operation, prolonging length of stay, and increased postoperative pain. IR interventions for PLL should be attempted prior to SDL, given its minimally invasive approach and low morbidity.