“…After experiencing complex cases of chyle leakage, we began providing ice cream preoperatively to prevent chyle leakage or fistula in patients scheduled to undergo LLND. Ice cream containing long-chain fatty acids is chylomicronized in the small intestine and increases lymphatic flow 3- to tenfold [ 6 , 18 ]. In the study by Shackcloth et al [ 7 ], patients were provided ice cream three hours before surgery; this safe method does not require special equipment and identifies the thoracic duct.…”
Section: Discussionmentioning
confidence: 99%
“…It is important to reduce chyle leakage occurrence using surgical techniques and treat such instances appropriately, based on chyle physiology, to avoid treatment-related difficulties. Visualization of the thoracic duct and some connecting lymphatic vessels can be improved after a fatty diet is consumed [ 6 , 7 ]. We investigated the possibility of preventing chyle leakage using physiological properties to avoid injuring the lymphatic ducts during surgery, pinpoint small chyle leakage, and repair such cases by increasing intrathoracic pressure before wound closure [ 1 ].…”
Purpose
This study investigated the effects of ice cream consumption on chyle leakage after left lateral neck dissection in patients with thyroid cancer.
Methods
A total of 491 patients with thyroid cancer underwent left lateral neck dissection with identification of the thoracic duct following ice cream consumption. Before closing the wound, the anesthesiologist increased the intrathoracic pressure to observe chyle leakage. If chyle leakage occurred postoperatively, the drain was removed using the drain negative pressure release test.
Results
Postoperative chyle leakage was observed in 18 of the 491 patients who underwent left lateral neck dissection. We treated 17 patients conservatively and 1 patient surgically. Drains were removed within five days in all patients. After the drain negative pressure release test had been performed in eight patients, the drainage volume significantly decreased from an average of 175 ml to 31 ml per day. The average number of days until the removal of the drainage tube was 3.2 days. No perioperative complications were associated with ice cream consumption.
Conclusions
In left lateral neck dissection for thyroid cancer, performing surgery following ice cream consumption does not completely prevent chyle leakage; however, early drain removal is possible because there is only mild leakage.
“…After experiencing complex cases of chyle leakage, we began providing ice cream preoperatively to prevent chyle leakage or fistula in patients scheduled to undergo LLND. Ice cream containing long-chain fatty acids is chylomicronized in the small intestine and increases lymphatic flow 3- to tenfold [ 6 , 18 ]. In the study by Shackcloth et al [ 7 ], patients were provided ice cream three hours before surgery; this safe method does not require special equipment and identifies the thoracic duct.…”
Section: Discussionmentioning
confidence: 99%
“…It is important to reduce chyle leakage occurrence using surgical techniques and treat such instances appropriately, based on chyle physiology, to avoid treatment-related difficulties. Visualization of the thoracic duct and some connecting lymphatic vessels can be improved after a fatty diet is consumed [ 6 , 7 ]. We investigated the possibility of preventing chyle leakage using physiological properties to avoid injuring the lymphatic ducts during surgery, pinpoint small chyle leakage, and repair such cases by increasing intrathoracic pressure before wound closure [ 1 ].…”
Purpose
This study investigated the effects of ice cream consumption on chyle leakage after left lateral neck dissection in patients with thyroid cancer.
Methods
A total of 491 patients with thyroid cancer underwent left lateral neck dissection with identification of the thoracic duct following ice cream consumption. Before closing the wound, the anesthesiologist increased the intrathoracic pressure to observe chyle leakage. If chyle leakage occurred postoperatively, the drain was removed using the drain negative pressure release test.
Results
Postoperative chyle leakage was observed in 18 of the 491 patients who underwent left lateral neck dissection. We treated 17 patients conservatively and 1 patient surgically. Drains were removed within five days in all patients. After the drain negative pressure release test had been performed in eight patients, the drainage volume significantly decreased from an average of 175 ml to 31 ml per day. The average number of days until the removal of the drainage tube was 3.2 days. No perioperative complications were associated with ice cream consumption.
Conclusions
In left lateral neck dissection for thyroid cancer, performing surgery following ice cream consumption does not completely prevent chyle leakage; however, early drain removal is possible because there is only mild leakage.
“…Recently, this empirical method involving administering olive oil has been reported to be useful. 13 , 14 This method can be used in conjunction with NIR fluorescence imaging with ICG. In this study ICG fluorescence was confirmed with preoperative 20% soy oil oral administration.…”
Section: Discussionmentioning
confidence: 99%
“…The benefit of intraoperative NIR fluorescence imaging with ICG is that it can be used in conjunction with conventional methods. Recently, this empirical method involving administering olive oil has been reported to be useful 13,14 . This method can be used in conjunction with NIR fluorescence imaging with ICG.…”
Chylothorax is a complication that occurs in about 1%-2% of esophagectomies, and it is a refractory complication that can induce pneumonia and sepsis. [1][2][3] Resection of the thoracic duct is considered a risk factor of metastatic recurrence to more organs. 4 On the other hand, Matsuda et al reported that thoracic duct resection during esophagectomy could increase the efficiency of lymph node dissection and improve the prognosis in early esophageal cancer. 5 Either way, intraoperative visualization of the
“…9 ). The existence of such paravertebral lymphatics may explain why the blockage/ligation of the thoracic duct in humans is well tolerated and does not necessarily produce LE [ 71 ]. Fig.…”
Section: Developmental Heterogeneity Of Somatic and Splanchnic Lympha...mentioning
Almost 400 years after the (re)discovery of the lymphatic vascular system (LVS) by Gaspare Aselli (Asellius G. De lactibus, sive lacteis venis, quarto vasorum mesaraicorum genere, novo invento Gasparis Asellii Cremo. Dissertatio. (MDCXXIIX), Milan; 1628.), structure, function, development and evolution of this so-called ‘second’ vascular system are still enigmatic. Interest in the LVS was low because it was (and is) hardly visible, and its diseases are not as life-threatening as those of the blood vascular system. It is not uncommon for patients with lymphedema to be told that yes, they can live with it. Usually, the functions of the LVS are discussed in terms of fluid homeostasis, uptake of chylomicrons from the gut, and immune cell circulation. However, the broad molecular equipment of lymphatic endothelial cells suggests that they possess many more functions, which are also reflected in the pathophysiology of the system. With some specific exceptions, lymphatics develop in all organs. Although basic structure and function are the same regardless their position in the body wall or the internal organs, there are important site-specific characteristics. We discuss common structure and function of lymphatics; and point to important functions for hyaluronan turn-over, salt balance, coagulation, extracellular matrix production, adipose tissue development and potential appetite regulation, and the influence of hypoxia on the regulation of these functions. Differences with respect to the embryonic origin and molecular equipment between somatic and splanchnic lymphatics are discussed with a side-view on the phylogeny of the LVS. The functions of the lymphatic vasculature are much broader than generally thought, and lymphatic research will have many interesting and surprising aspects to offer in the future.
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