AB143. SOH24AB_173. The multimodal management of chyle leak post oesophagectomy: conservative, radiological and surgical approaches

Background: Chyle leaks remain a persistent contemporaneous complication post oesophageal oncological resection and can be associated with considerable morbidity and in extreme circumstances mortality. There is no international consensus on its management with conservative/medical, surgical, or interventional radiological (IR) strategies all valid practices depending on expertise and clinical circumstances. Minimally invasive IR procedures as an alternative to thoracic duct ligation are proving popular in recent times, being employed in multiple centres.

Methods: Herein we report on an institutional experience in the treatment strategies to manage chyle leaks.

Results: The first case, a 49-year-old man post 3-stage esophagectomy was found to have a chyle leak day 3 post operatively. Conservative and subsequently surgical management were employed, however ultimately pioneering IR measures at out centre via lymphangiography and thoracic duct embolization (TDE) were utilised. The second case an 81-year-old man who underwent a transhiatal oesophagectomy for a type I stenosing poorly differentiated junctional adenocarcinoma on a background of Barrett’s oesophagus. On post operative day-10, he was diagnosed with a large chylothorax. In this case the decision was made to proceed directly to TDE in the IR department rather than conservative or surgical strategies. Similarly, the third case, a 63-year-old-man post 2 stage oesophagectomy, failed conservative management and proceeded to need 2 attempts at IR management which ultimately proved successful.

Conclusions: The advent of IR modalities such as TDE or thoracic duct disruption (TDD), to manage chyle leaks which fail to respond to medical and conservative modalities obviates the need to progress to surgical management in many cases thereby avoiding the morbidity associated with thoracoscopic and open surgical management.

Keywords: Chyle leak; dietary modification; somatostatin; thoracic duct embolization (TDE); thoracic duct ligation