From the Guidelines
Management of chyle leak post thyroidectomy should initially focus on conservative measures, with a stepwise approach to more invasive therapies if necessary, prioritizing thoracic duct embolization (TDE) as a highly effective percutaneous alternative to surgical thoracic duct ligation, with a clinical success rate of up to 90% in traumatic cases and 64% in nontraumatic cases, as reported by Itkin et al [@5@] and Pamarthi et al [@7@].
When managing chyle leaks post thyroidectomy, it is crucial to first confirm the diagnosis by draining the fluid for studies, which also serves as a palliative measure [1@]. The decision between conservative and invasive therapies depends on daily outputs, with higher outputs necessitating a more aggressive approach [1@]. Conservative measures include managing the underlying disease, thoracentesis, and dietary modifications such as total parenteral nutrition or a nonfat diet to reduce chyle production [1@].
Some key points to consider in the management of chyle leaks include:
- The success of conservative therapy approaches 50% in nonmalignant etiologies but is only minimally beneficial in neoplastic etiologies [1@].
- Invasive treatments, including surgical thoracic duct ligation, pleurodesis, and TDE, are considered if conservative treatment has not resolved the chylothorax after 2 weeks, in higher-output chylothoraces, and in underlying neoplastic etiologies [1@].
- TDE has been shown to have higher clinical success in treating traumatic compared to nontraumatic chyle leaks, with a lower rate of acute complications, estimated at 2% to 6% [5@, 6@, 7@].
- Long-term complications of TDE may include leg swelling, abdominal swelling, or chronic diarrhea, seen in up to 14% of patients [1
From the Research
Management of Chyle Leak Post Thyroidectomy
- Chyle leak is a rare complication after thyroidectomy, with an incidence of 0.9% 1.
- The management of chyle leak can be conservative or surgical, depending on the severity of the leak.
- Conservative management includes a low-fat diet and observation 2, as well as total parenteral nutrition 3.
- Somatostatin analogs have been used as a new conservative therapeutic approach for the treatment of chyle fistulas 3.
- Dietary modification, such as NPO, can be effective in reducing chyle drainage 1.
Treatment Options
- Medical treatment options for chyle leak include fat-free oral diet or parenteral nutrition without oral intake, and pharmacological treatment (primarily octreotide) 4.
- Minimally invasive treatments, such as percutaneous lymphatic embolization and thoracic duct disruption, have been shown to be safe and effective 5.
- Surgical management should be considered if the drainage amount does not decrease by >50% of the original amount of the day of detection after 2 days of NPO 1.