Management of thoracic duct injuries after oesophagectomy

Background: Thoracic duct laceration is a rare but potentially life-threate ning complication of oesophagectomy. The management of such an injury is un certain in respect of the relative merits of conservative and surgical trea tment. Methods: The literature was reviewed by searching Medline databases from 19 66 to the present time. The majority of the evidence presented is level 3, as no randomized or controlled data are available. Results: Prolonged conservative treatment of thoracic duct injury is associ ated with a mortality rate of 50-82 per cent. The results of early surgical ligation of the duct are more encouraging, with a mortality rate of 10-16 per cent. Elective ligation of the duct reduces the incidence of postoperat ive chylothorax. Conclusion: The thoracic duct should be ligated during oesophagectomy. A hi gh index of suspicion for duct injury must be maintained in all patients af ter operation. A policy of very early thoracic duct ligation at 48 h from d iagnosis is proposed for duct injury if aggressive conservative management fails.