Results
Eight patients developed CL post neck surgery (on average 3-5 neck dissections are performed in our unit ~1.6% of the estimated number of lateral neck dissections). Patients developed CL between 1 and 7 days post neck surgery. One patient had an intra-operative CL noted which was addressed at the time of neck dissection but had chyle in the drain on day 1 post-operatively. There were 5 males and 3 females. Median age was 35 (range 24-75 years) (Table 1). All patients had left neck dissections with 7 being bilateral. 5 patients had total thyroidectomies, two had total laryngectomies and one patient had partial glossectomy. All 8 patients had left sided level 4 neck lymph node dissections.
One patient had a low volume CL with 200mls/ 24 hours managed medically with fat free diet, orlistat and octreotide for 22 days on outpatient basis as the patient declined surgical intervention and the CL eventually resolved. One patient had moderate volume CL and was managed medically for 7 days and due to persistence of CL then underwent VATS TD ligation. Six patients developed high volume CL from the outset and were managed both medically and surgically with fat free diet, orlistat and octreotide and then had TD ligation by VATS (date range 2- 9 days after onset of CL). CL resolved within 24 hours of ligation in all patients. There were no VATS TD ligation related complications. Length of inpatient stay ranged from 3 to 35 days, and were dependent on non-chyle leak related factors. Table 2 summarises the volume stratification of CL and their management.