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.