Comparison with other studies
Failed medical therapy or surgical re-exploration of the neck may fail
and further delay definitive treatment as postoperative inflammation
makes the TD more difficult to identify3. Delayed
therapy increases the likelihood of complications. Previously published
studies corroborate our results in that VATS ligation of the TD
expediently halts the high drain output, and avoids the surgical
morbidity associated with open thoracotomy8.
VATS TD ligation is a low morbidity procedure and thus patients could
potentially be discharged earlier9. The shorter
duration of CL means they are less likely to develop metabolic,
nutritional and immune complications. The resolution of CL after VATS TD
ligation promotes an enhanced recovery of head and neck patients.
VATS ligation of the TD is an effective surgical approach of treating CL
demonstrated by the 100% success rate of this case series. It has been
shown to have high success and minimal complications rates compared to
open thoracotomy8. Ilczyszyn et al9reviewed a series of case reports and concluded that thoracoscopic
ligation is effective at stemming intractable chyle fistulas, with no
added morbidity. In addition, it avoids the significant risk of
morbidity associated with major thoracic access thus decreasing hospital
stay10.
This study adds to the body of evidence in the management of CL by
providing guidance on the timeframe for medical management and when to
consider surgical intervention. In addition, to our knowledge, it is the
largest case series reporting on outcomes of VATS TD ligation procedure
for CL management after neck dissection. Akin to the systematic review
of CL medical management5, a systematic review and
meta-analysis of the surgical management of CL would add valuable
evidence to the management of this rare complication of neck dissection.