Discussion
Management of CL is challenging, however, early stratification by the volume of CL can aid effective management. Postoperative medical management measures, including fat-free diet, correction of metabolic imbalances, somatostatin analogues (octreotide)5, lipase inhibitors (Orlistat)6 and TPN (Total parenteral nutrition) are often employed, however, if these are ineffective, surgical interventions would be necessary. Lymphangiography with sclerotherapy in the management of CL has also been reported in the literature7. The key findings from this quality improvement project is that low and medium-volume leaks are managed medically with a defined timeframe to consideration of surgical intervention in the form of VATS TD ligation if the CL is not resolving. High volume CL are commenced on medical management initially whilst early arrangements for a surgical intervention is encouraged. The data from this study indicates that VATS TD ligation is a safe and effective procedure with all CL resolved by day 1 post VATS TD ligation.