S A Wemyss-Holden1, B Launois, G J Maddern. 1. University of Adelaide Department of Surgery, Queen Elizabeth Hospital, Woodville Road, Woodville, South Australia 5011, Australia.
Abstract
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.
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.
Authors: Sameh R Ismail; Mohamed S Kabbani; Hani K Najm; Ghassan A Shaath; Abdulraouf M Z Jijeh; Omar M Hijazi Journal: J Saudi Heart Assoc Date: 2014-01-13
Authors: Rachit D Shah; James D Luketich; Matthew J Schuchert; Neil A Christie; Arjun Pennathur; Rodney J Landreneau; Katie S Nason Journal: Ann Thorac Surg Date: 2012-01-15 Impact factor: 4.330
Authors: Michael Kranzfelder; Ralf Gertler; Alexander Hapfelmeier; Helmut Friess; Marcus Feith Journal: Surg Endosc Date: 2013-05-25 Impact factor: 4.584