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chyle leak

Sean W Delaney, Haoran Shi, Alireza Shokrani, Uttam K Sinha
Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body. Chyle extravasation can result in delayed wound healing, dehydration, malnutrition, electrolyte disturbances, and immunosuppression. Prompt identification and treatment of a chyle leak are essential for optimal surgical outcome...
2017: International Journal of Otolaryngology
L Findlay, C Yao, D H Bennett, R Byrom, N Davies
BACKGROUND: The trend towards laparoscopic surgery seen in other specialties has not occurred at the same pace in oesophagectomy. This stems from concerns regarding compromised oncological clearance, and complications associated with gastric tube necrosis and anastomotic failure. We present our experience of minimally invasive oesophagectomy (MIO) compared to open and hybrid surgery. We aim to ascertain non-inferiority of MIO by evaluating impact on survival, oncological clearance by resection margin and lymph node harvest and post-operative complications...
January 11, 2017: Surgical Endoscopy
Gregory Nadolski
Nontraumatic chylothorax is a relatively rare condition in which the intestinal lymph (chyle) leaks into the pleural cavity. Nontraumatic chylothorax is more difficult to treat than the more common traumatic chylothorax because the site of chylous leak may occur in less predictable locations. In the past, patients with nontraumatic chylothoraces were offered traditional fluoroscopically guided lymphangiography and thoracic duct embolization similar to traumatic chylothorax. However, the observation that thoracic duct embolization outcomes for nontraumatic chylothorax differed based on the imaging findings during lymphangiography has led to the development of a treatment algorithm, which incorporates noninvasive diagnostic studies, such as magnetic resonance lymphangiography...
December 2016: Techniques in Vascular and Interventional Radiology
Michael S Stecker, Chieh-Min Fan
Lymph leaks resulting in chylous pleural effusions can be life-threatening. Minimally invasive thoracic duct embolization and disruption have been gaining acceptance as first-line treatment for these leaks. This review discusses the techniques for both pedal and intranodal lymphangiography in detail. It also discusses the use of lymphangiography as a means of targeting a retroperitoneal lymphatic to facilitate thoracic duct interventions for chyle leaks. Finally, outcomes and adverse events pertaining to these thoracic duct interventions are discussed...
December 2016: Techniques in Vascular and Interventional Radiology
D G Zhang, L Gao, L Xie, G F He, L Fang, J Chen, Y W Miao, Z Z Wang
Objective: To discuss the feasibility, safety and oncologic completeness of modified minimally invasive video-assisted lateral neck dissection (MIVALND) for papillary thyroid carcinoma. Methods: Data of 130 patients from Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical School, Zhejiang University undergoing MIVALND from January 2013 to September 2015 were reviewed retrospectively. There were 31 male and 99 female patients with the mean age of (39±11) years. The thyroidectomy and central compartment dissection were performed under a direct visual field or video-assisted (VA) approach, lateral neck dissection was performed via the VA approach...
November 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
O Strobel, S Brangs, U Hinz, T Pausch, F J Hüttner, M K Diener, L Schneider, T Hackert, M W Büchler
BACKGROUND: Chyle leak is a well known but poorly characterized complication after pancreatic surgery. Available data on incidence, risk factors and clinical significance of chyle leak are highly heterogeneous. METHODS: For this cohort study all patients who underwent pancreatic surgery between January 2008 and December 2012 were identified from a prospective database. Chyle leak was defined as any drainage output with triglyceride content of 110 mg/dl or more...
January 2017: British Journal of Surgery
Marc G Besselink, L Bengt van Rijssen, Claudio Bassi, Christos Dervenis, Marco Montorsi, Mustapha Adham, Horacio J Asbun, Maximillian Bockhorn, Oliver Strobel, Markus W Büchler, Olivier R Busch, Richard M Charnley, Kevin C Conlon, Laureano Fernández-Cruz, Abe Fingerhut, Helmut Friess, Jakob R Izbicki, Keith D Lillemoe, John P Neoptolemos, Michael G Sarr, Shailesh V Shrikhande, Robert Sitarz, Charles M Vollmer, Charles J Yeo, Werner Hartwig, Christopher L Wolfgang, Dirk J Gouma
BACKGROUND: Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. METHODS: The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation...
February 2017: Surgery
Charles D Meyer, Ian K McLeod, Daniel J Gallagher
Chyle leaks are a rare but potentially fatal complication of head and neck surgery carrying an incidence as high as 8.3%. The development of a chyle leak carries significant morbidity ranging from delayed wound healing to oropharyngeal fistulas. Presented here is a case of a chyle leak that developed following a left posterolateral neck dissection that was successfully managed with a combination of drain suction, pressure dressing, and a fat-restricted diet. However, the patient's course was complicated by repeated chyle leak recurrences that may have been associated with the initiation of medium-chain triglyceride supplementation...
September 2016: Military Medicine
Carlos J Guevara, Kristy L Rialon, Raja S Ramaswamy, Seung K Kim, Michael D Darcy
PURPOSE: To describe technical details, success rate, and advantages of direct puncture of the thoracic duct (TD) under direct ultrasound (US) guidance at venous insertion in the left neck. MATERIALS AND METHODS: All patients who underwent attempted thoracic duct embolization (TDE) via US-guided retrograde TD access in the left neck were retrospectively reviewed. Indications for lymphangiography were iatrogenic chyle leak, pulmonary lymphangiectasia, and plastic bronchitis...
December 2016: Journal of Vascular and Interventional Radiology: JVIR
Andres A Mardonado, Ru Chen, David W Chang
BACKGROUND AND OBJECTIVES: Vascularized lymph node transfer (VLNT) is gaining popularity for treatment of lymphedema. The purpose of this study was to evaluate the flap and the donor site morbidity of the supraclavicular (SC) VLNT. METHODS: A review of a prospective database was performed for patients who had undergone SC VLNT to treat upper or lower extremity lymphedema. Flap and donor site complications were registered for each patient. A detailed technical surgical approach is explained...
January 2017: Journal of Surgical Oncology
Jung-Woo Woo, Seo Ki Kim, Inhye Park, Jun Ho Choe, Jung-Han Kim, Jee Soo Kim
INTRODUCTION: Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RT) is proven to be a feasible method for the treatment of well-differentiated thyroid cancers in terms of oncology as well as cosmesis. However, BABA RT causes postoperative sternal discomfort and needs an incision over the nipple areolar area. Here, we suggest a novel robotic surgical technique for thyroid surgery that does not need a breast incision-bilateral axillary approach (BAA). PATIENTS AND METHODS: We recruited 51 patients who were willing to undergo the novel BAA robotic thyroid surgery...
February 2017: Surgical Endoscopy
Ming-Sing Si
No abstract text is available yet for this article.
September 2016: Journal of Thoracic and Cardiovascular Surgery
Matthew T McMillan, Giuseppe Malleo, Claudio Bassi, Valentina Allegrini, Luca Casetti, Jeffrey A Drebin, Alessandro Esposito, Luca Landoni, Major K Lee, Alessandra Pulvirenti, Robert E Roses, Roberto Salvia, Charles M Vollmer
OBJECTIVE: This multicenter study sought to prospectively evaluate a drain management protocol for pancreatoduodenectomy (PD). BACKGROUND: Recent evidence suggests value for both selective drain placement and early drain removal for PD. Both strategies have been associated with reduced rates of clinically relevant pancreatic fistula (CR-POPF)-the most common and morbid complication after PD. METHODS: The protocol was applied to 260 consecutive PDs performed at two institutions over 17 months...
June 24, 2016: Annals of Surgery
M Atie, G Dunn, G L Falk
INTRODUCTION: Chyle leak after oesophagectomy is highly morbid and may carry significant mortality if treatment is delayed. Identification of the site of leakage and surgery may be plagued by failure. PRESENTATION OF CASE: We describe a case of chyle leak after oesophagectomy. Lymphangiography revealed the site of chyle leak to be an aberrant duct that would have been difficult to identify surgically. Radiological coiling and embolization successfully treated the leak...
2016: International Journal of Surgery Case Reports
Kazuki Moro, Yu Koyama, Shin-Ichi Kosugi, Takashi Ishikawa, Hiroshi Ichikawa, Takaaki Hanyu, Kohei Miura, Masayuki Nagahashi, Masato Nakajima, Kumiko Tatsuda, Junko Tsuchida, Chie Toshikawa, Mayuko Ikarashi, Yoshifumi Shimada, Jun Sakata, Takashi Kobayashi, Hitoshi Kameyama, Toshifumi Wakai
BACKGROUND AND AIMS: Transthoracic esophagectomy using 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most aggressive gastrointestinal surgeries. Early enteral nutrition (EN) for TTE-3FL patients is useful and valid for early recovery; however, EN using a fat-containing formula risks inducing chyle leak. In the present study, we retrospectively examined esophageal cancer patients treated byTTE-3FL and administered postoperative EN to elucidate the validity of lowering the fat levels in elemental formulas to prevent postoperative chyle leak and improve postoperative recovery...
December 2016: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Dingyi Liu, Weimu Xia, Qi Tang, Jian Wang, Mingwei Wang, Chongyu Zhang, Wenlong Zhou, Jianxin Shi, Qianjun Zhou, Heng Zhang, Yewei Xie, Yuan Shao
OBJECTIVE: To identify the value of lymphography in the location and treatment decision of chyle leakage. METHODS: The clinic data of 177 patients suffered from chyle leakage admitted in 6 medical centers in Shanghai from February 1998 to December 2014 was analyzed retrospectively. There were 94 male and 83 female patients aging from 9 to 84 years with a mean of 49 years, including 128 cases of chyluria, 34 cases of primary chylothorax and 15 cases of other chyle leakage...
April 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Hideki Aoki, Masashi Utsumi, Kenta Sui, Nobuhiko Kanaya, Tomoyoshi Kunitomo, Hitoshi Takeuchi, Norihisa Takakura, Shigehiro Shiozaki, Hiroyoshi Matsukawa
AIM: To investigate changes over time in, and effects of sealing technology on, milk test results following pancreatectomy. METHODS: From April 2008 to October 2013, 66 pancreatic resections were performed at the Iwakuni Clinical Center. The milk test has been routinely conducted at the institute whenever possible during pancreatectomy. The milk test comprises the following procedure: A nasogastric tube is inserted until the third portion of the duodenum, followed by injection of 100 mL of milk through the tube...
March 27, 2016: World Journal of Gastrointestinal Surgery
Noelia Escobedo, Steven T Proulx, Sinem Karaman, Miriam E Dillard, Nicole Johnson, Michael Detmar, Guillermo Oliver
Prox1 heterozygous mice have a defective lymphatic vasculature and develop late-onset obesity. Chyle abnormally leaks from those vessels, accumulates in the surrounding tissues, and causes an increase in adipose tissue. We characterized the lymphatics of Prox1(+/-) mice to determine whether the extent of obesity correlated with the severity of lymphatic defects. The lymphatic vasculature in Prox1(+/-) mice exhibited reduced tracer clearance from the ear skin, dysfunctional perfusion of the lower legs, and reduced tracer uptake into the deep lymphatic collectors during mechanostimulation prior to the onset of obesity...
February 1, 2016: JCI Insight
Francesca De Felice, Daniela Musio, Angela Musella, Mario Tombolini, Vincenzo Tombolini
Chyle leak after neck dissection is a relatively rare complication in head and neck cancer scenario.This review summarizes the basic knowledge of chyle leak underlying the potential benefit induced by low-dose radiation therapy and may serve as basis for future studies, necessary to optimize chyle leak management in head and neck cancer patients.
March 2016: Journal of Craniofacial Surgery
Elena González-Sánchez-Migallón, José Aguilar-Jiménez, José Andrés García-Marín, José Luis Aguayo-Albasini
Chyle leak following axillary lymph node clearance is a rare yet important complication. The treatment of postoperative chyle fistula still remains unclear. Conservative management is the first line of treatment. It includes axillary drains on continuous suction, pressure dressings, bed rest, and nutritional modifications. The use of somatostatin analogue is well documented as a treatment for chylous fistulas after neck surgery. We present a case of chylous fistula after axillary surgery resolved with the use of octreotide...
2016: Case Reports in Surgery
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