This video demonstrates the drainage of a subcarinal collection via mediastinoscopy in a patient who had recently undergone esophagectomy. The chyle leak was localized over the gastric conduit and unsuccessfully drained percutaneously. However, computed tomography imaging showed a 4.9 mm margin inferior to the carina whereby drainage could be accomplished via mediastinoscopy.
Postoperative chylous leakage is a rare but well-documented complication of esophagectomy, with an incidence varying from 1.3-3.4% following procedures involving the thorax or the neck. Chyle leakage is a serious complication, with mortality ranging from 0 to 50%, due to significant loss of fluid, plasma protein, and immunoregulatory lymphocytes. Symptomatic patients exhibit signs of severe malnutrition, hyponatremia, acidosis, hypocalcemia, and increased susceptibility to infection.
Additional Resources
- Lagarde SM, Omloo JMT, de Jong K, Busch OR, Obertop H, van Lanschot JJ. Incidence and management of chyle leakage after esophagectomy. Ann Thorac Surg. 2005;80(2):449-454.
- Tamura T, Kubo N, Yamamoto A, et al. Cervical chylous leakage following esophagectomy that was successfully treated by intranodal lipiodol lymphangiography: a case report. BMC Surg. 2017;17(1):20.
