Usefulness of thoracic duct clipping in thoracoscopic surgery for chylous fistula occurring after neck dissection

Chylous fistula is a rare complication after neck dissection. No methods of treatment have been established and conservative treatment is problematic in many cases. The present case report concerns a 79-year-old man in whom we performed total pharyngolaryngectomy, bilateral neck dissection, and free jejunum transfer for stage II hypopharyngeal cancer. On day 5 following surgery, chylous fistula was observed in the left neck. As no improvement was seen with conservative therapy comprising a low-fat diet and octreotide, we performed thoracoscopic thoracic duct clipping on day 28 following surgery. Directly after clipping, chylous leakage stopped. Oral food ingestion was resumed the following day and the patient was discharged within a week. In view of its low invasiveness and few complications, thoracoscopic thoracic duct clipping may offer a good therapeutic option for chylous fistula.