Method
The revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) reporting methodology was adopted. A retrospective case series review was conducted of all patients who developed clinically & biochemically confirmed CL following neck dissection for malignant head and neck and thyroid disease between 2010 and 2019 at a tertiary head and neck unit. Patients were managed as per the aforementioned unit guidelines. In the multi-disciplinary management of patients, dietary modifications were managed by dieticians and the VATS TD ligation procedure were performed by the thoracic surgeons.
Medical management consisted of fat-free diet, orlistat and octreotide. Surgical management via TD ligations by VATS procedure was carried out when indicated.
During the VATS TD ligation, detection of the TD is achieved by using a right-sided lateral approach to the thorax. The TD is subsequently occluded by mass ligation of the tissue superior to the supra-diaphragmatic hiatus, which lies between the aorta and the azygos vein (figure 2).
Cessation of CL was defined as the termination of chyle like fluid from the neck or the neck drain with biochemical confirmation.