Repair of major lymphatic duct injury during laparoscopic sleeve gastrectomy

Lymphatic Chyle Duct Injury and Identification During Laparoscopic Sleeve Gastrectomy Preventing Postoperative Chylous Ascites

We present a case of intraoperative detection of an iatrogenic chyle duct injury during laparoscopic sleeve gastrectomy. The chyle duct injury was identified and managed by ligature, preventing postoperative chylous ascites.

Chyloperitoneum and Chylothorax Following Bariatric Surgery: a Systematic Review

Chyloperitoneum and chylothorax (ChP/ChT) are rare complications after bariatric surgery. This systematic review aims to evaluate the incidence, cause, treatment, and outcome of ChP and ChT after bariatric surgery. This review investigates published English language scientific literature systematically in an attempt to answer these questions. Our literature search revealed 66 studies, of which 23 were included. There were a total of 40 patients (38, ChP; 2, ChT). Eighteen of 40 (43.9%) patients were treated laparoscopically, and one patient (2.44%) underwent thoracoscopy and ligation of the thoracic duct. Both ChP and ChT are rare complications after bariatric surgery.

Lymphatic leakage after laparoscopic sleeve gastrectomy; presentation, management and review of the literature

The lymphatic system is a vital network of lymphatic vessels that carries liquid fluids, long-chain fatty acids and proteins from capillaries back to the vascular system and clears interstitial debris and bacteria. Lymphatic leakage is a condition not uncommon after many abdominal surgeries. It can lead to immunodeficiency and nutritional abnormalities. Moreover, it has high morbidity and mortality, ranging between 40% and 70%, depending on the presence of an underlying condition. A few lymphatic leakage cases after bariatric surgery have been reported in the literature. We report the first case of lymphatic leakage after sleeve gastrectomy, which was treated with conservative treatment.

Life threatening presentation of thoracic duct injury post thyroid surgery; a case report

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Injury to thoracic duct, and the formation of chyle leak, is a rare complication and carries significant metabolic and immunological consequences.

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Thoracic duct injury during thyroid surgery is an uncommon event with an incidence rate of 0.5–1.8%.

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High output chyle leak in a confined space was life threatening.

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Surgeons must be familiar with thoracic duct anatomy.

Background

Injury to thoracic duct is a rare potential complication of time-honored conventional thyroidectomy. Nevertheless, it can be a cause of significant morbidity, and sometimes life-threatening.

Patient findings

A 78-year-old female patient with a previous surgical history of thyroid lobectomy for nodular disease presented with primary hyperparathyroidism, and a nodule in the remaining thyroid lobe. The patient underwent completion thyroidectomy and parathyroidectomy. Less than 24 h post operatively, the patient developed progressive shortness of breath and neck swelling requiring immediate intubation and re-exploration. A large amount of chyle was drained and an injured thoracic duct was identified and ligated.

Summary

In experienced hands thyroid surgery is safe. Nevertheless, factors such as the type of pathology and its extent, the level of surgery, and re-operative surgery increase the risk of postoperative complications. Immediate surgical exploration is necessary when patients present with neck swelling and respiratory distress. In our case, a high output chyle leak in a confined space was life threatening.

Conclusion

Timely re-exploration following thyroid surgery and thorough knowledge of the anatomy of neck structures is crucial in sparing patients potential morbidity and/or mortality.