Cervical thoracic duct injury: our experience

Cervical lymphatic fistula is a severe but rare complication after thyroid surgery. It appears to be more common during radical or functional lymphatic dissection of the posterior triangle and V level. In the period from January 1989 to December 2013, 16 cervical chylous fistulas have been treated in our Department. Seven fistulas happened in our clinical practice while 9 were referred to our service from other hospitals. Five/19 followed total thyroidectomy, 1/19 was related to bilateral neck lymphectomy while monolateral lymphnode dissection was performed before the onset of the remaining 10 fistulas. The finding of an active lymphatic leak allowed a prompt surgical repair in 2 cases. Among the 5 cases of "low-flow" fistula, 4 healed after conservative therapy but 1 required surgery. Out of the 9 cases of "high-flow" fistula, 5 were submitted to surgery during the first post-operative week, 1 between the first and the second week, and 3 between the 15th and 30th postoperative day. Right supra-diaphragmatic lymphatic duct ligation was performed once by videothoracoscopic approach.