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

Abstract

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.