Efficiency of intranodal lymphangiography in the treatment of postoperative lymphatic leakage.

Background: This study aimed to evaluate the safety and efficacy of intranodal lymphangiography (IL) for the treatment of postoperative chyle leakage (CL), chylothorax, and chylous ascites.

Methods: Between April 2018 and July 2022, eight patients who underwent IL for CL following thyroid and thoraco-abdominal surgeries were included in this retrospective study. Among these eight patients, six underwent bilateral total thyroidectomy, one underwent lobectomy of the lung, and one underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Prior to the procedure, thoracic duct ligation was attempted in one patient. Lymphangiographic findings, technical and clinical success rates, and complications were analyzed. Technical success was defined as the successful ultrasound-guided puncture of an inguinal lymph node and the opacification of the lymphatic system in the pelvis and abdomen by fluoroscopy. Clinical success was defined as a progressively decreasing drain output, culminating in the cessation of output within one week after the procedure.

Results: Technical and clinical success was achieved in all patients. On lymphangiography, ethiodized oil leakage near the surgical bed was identified in seven of the eight patients. The median time from the procedure to drain removal was three days (range: 1-6 days) for patients who underwent surgical drainage. No recurrence of CL, chylothorax, or chylous ascites was observed during the follow-up period (range: 21-73 months; median: 38 months).

Conclusion: Intranodal lymphangiography appears to be a safe and effective minimally invasive treatment option for CL following thyroid and thoraco-abdominal surgeries, demonstrating acceptable technical and clinical success rates.