High‐output chyle leak after breast‐conserving surgery and sentinel lymph node biopsy

Abstract

Postoperative chyle leak is an exceedingly rare complication following breast and axillary surgery. We present the first described case of chyle leak following breast‐conserving surgery and sentinel lymph node biopsy. Management should begin with appropriated conservative measures aimed at reduction of lymph production and flow. Intervention is warranted when conservative strategies fail and include sclerotherapy, lymphangiography, embolization, and surgery. Breast surgeons should be mindful of this potential complication when operating in the axilla and be familiar with its stepwise management.

A case report of chyle leakage after axillary node clearance in a patient with breast cancer

“…Precise compression site plays an important role in efficacy. Inject meglumine diatrizoate: If the methods above fail to work, consider injecting meglumine diatrizoate through the drainage tube 17–19 . Meglumine diatrizoate's viscous characteristics make it possible to coalesce the leaking lymphatic vessels, by stimulating a traumatic adhesion. Adopt Lymphangiography: Lymphangiography can accurately identify leaking points for follow‐up pressure bandaging or surgical suturing 12,16 Perform secondary surgery: Fistulas that do not respond to conservative treatment in 1 week or persistent leaking over 500 mL/24 h indicate a re‐exploration without delay. …”

“…12,16 6. Perform secondary surgery: Fistulas that do not respond to conservative treatment in 1 week or persistent leaking over 500 mL/24 h indicate a re-exploration without delay.…”

Chylous Leakage After Breast-Conserving Surgery and Axillary Clearance: Case Report and Management Strategies

“…David T Pointer Jr described a case of chyle leak after breast-conserving surgery and sentinel lymph node biopsy. The celiac leakage was discovered at the site of a sentinel lymph node biopsy rather than in the breast ( 6 ). The other cases occurred after mastectomy and axillary lymph node dissection, which had more extensive surgery than our presented case ( 7 , 8 ).…”

“…Surgical intervention of chyle leak, on the other hand, has been discussed in a number of studies ( 6 , 14 , 15 ). Some authors believe that early surgical intervention may be beneficial in patients who have failed to respond to initial dietary and/or medical interventions.…”

“…Because the risk of re-exploration of the axilla and breast is low, and earlier chylous fistula ligation can prevent subsequent oncologic treatments from being delayed, the damaged lymphatic channel is directly ligated during surgery. Intraoperative orogastric or nasogastric boluses of “heavy cream,” as demonstrated by Pointer and colleagues, can aid in the identification of the leaking vessel ( 6 ). As an alternative, plugging with gel foam, adhesive, local muscle rotation flaps, or other packing materials could be considered.…”