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.