Alberti Luca,Bencivenga Maria,CA De Pasqual,Gervasi Maria Clelia ,Giacopuzzi Simone,Jacopo Weindelmayer,Ridolfi Cecilia,Sacco Michele,
Minimally Invasive Treatment of Chyle Leak After Esophagectomy Using Indocyanine Green (Icg) Enhanced Fluorescence: A Case Report
Surgical Case Reports
2019
2613-5965
http://dx.doi.org/10.31487/j.SCR.2019.06.09
https://www.sciencerepository.org/minimally-invasive-treatment-of-chyle-leak-after-esophagectomy_SCR-2019-6-109 
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.Keywords: Esophagectomy, chylotorax, indocyanine green