Minimally Invasive Treatment of Chyle Leak After Esophagectomy Using Indocyanine Green (Icg) Enhanced Fluorescence: A Case Report

Author Info

Alberti Luca Bencivenga Maria CA De Pasqual Gervasi Maria Clelia Giacopuzzi Simone Jacopo Weindelmayer Ridolfi Cecilia Sacco Michele

Corresponding Author

CA De Pasqual
Division of General and Upper GI Surgery, Department of Surgery, University of Verona, Verona, Italy

A B S T R A C T

Chyle Leak (CL) is a relative rare but deadly complication after esophagectomy. The optimal management of CL is still unclear; however, a surgical re-intervention is usually considered necessary if the daily output from the thoracic drain exceeds 1 L. In case of re-intervention, surgical ligature of the thoracic duct (TD) is often resolutive, although TD visualization can be challenging in this setting. We report the case of a 66 years old male patient submitted to total minimally invasive Mc Kewon esophagectomy, who in the postoperative course developed a CL. After a first unsuccessful attempt of conservative management, we decided to re-submit the patient to surgery with a thoracoscopic approach. During the procedure, we injected the indocyanine green into the inguinal lymph nodes bilaterally. The fluorescence images allowed us to: 1- visualize the thoracic duct; 2- identify the exact site of the leak; 3- to confirm (after TD selective ligature) that the leak was correctly sealed. In two subsequent esophagectomies we used the same technique to intraoperatively identify the TD, allowing its prophylactic selective ligature.

Article Info

Article Type

Case Report

Publication history

Received: Mon 04, Nov 2019
Accepted: Mon 25, Nov 2019
Published: Mon 30, Dec 2019

Copyright

© 2023 CA De Pasqual. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.SCR.2019.06.09