Lymphorrhea in thyroid surgery

The aim of the study ? to develop methods for preventing damage to the thoracic duct, conservative and surgical lymphorrhea treatment. Materials and methods. Analysis for lymphorrhea was performed in 736 patients after thyroid surgery and regional lymph tracts. 539 operations were performed without preoperative thoracic duct contrasting and 197 operations with high concentration triglyceride contrast. Therapeutic lymphorrhea correction was performed if the daily flow rate was up to 500 ml. In the case if conservative therapy was ineffectiveness and lymphorrhea was of more than 600?800 ml per day surgical correction of lymphorrhea was performed. Results and discussion. The analysis of 19 cases with moderate (up to 500 ml/day) and mid-severe (600?1500 ml/day) lymphorrhea was performed. In 16 (84,2%) cases lymphorrhea was observed from the left side of the neck , in 3 from the right side of the neck. Incidence of lymphorrhea was 2,3 times higher (2,1% vs 4,8%) in repeat surgeries and on an average made upto 3,5% in the cases without lymphatic duct contrasting. Contrasting lymphatic vessels before surgery reduced this figure to 0,5%. In the case of moderate lymphorrhea (about 90%) 8 patients the therapy was conservative, they were observed within 8±5,4 days; out of which 7 patients (87,5%) showed a positive trend. In one case (12,5%) after the failure of conservative therapy for 13 days, surgical closure of thoracic duct defect was carried out. Surgical lymphorrhea correction was done in 11 patients with moderate-severe lymphorrhea, thoracic duct defect was sutured with synthetic suture material in 9 (81,8%) patients, in 3 (18,2%) patients muscle-fat graft plug method was used. Conclusions. Intraoperative damage of thoracic duct is related not only to the variability in the anatomy of the lymphatic vessels, but also due to the complexity of their visualization due to ?fasting mode? of a patient. Using triglycerides as a lymphatic vessel marker three hours prior to surgery is a highly effective and safe method of preventing damage to the thoracic duct and its branches. When lymphorrhea is up to 500 ml, conservative treatment is possible, when it exceeds 600 ml/day a surgical correction is recommended. The use of local muscle-fat grafts in addition to suturing the source of lymphorrhea provides greater efficiency in closing chyle fistulas.