Postesophagectomy Drainage of Subcarinal Collection via Mediastinoscopy

This video demonstrates the drainage of a subcarinal collection via mediastinoscopy in a patient who had recently undergone esophagectomy. The chyle leak was localized over the gastric conduit and unsuccessfully drained percutaneously. However, computed tomography imaging showed a 4.9 mm margin inferior to the carina whereby drainage could be accomplished via mediastinoscopy.

Postoperative chylous leakage is a rare but well-documented complication of esophagectomy, with an incidence varying from 1.3-3.4% following procedures involving the thorax or the neck. Chyle leakage is a serious complication, with mortality ranging from 0 to 50%, due to significant loss of fluid, plasma protein, and immunoregulatory lymphocytes. Symptomatic patients exhibit signs of severe malnutrition, hyponatremia, acidosis, hypocalcemia, and increased susceptibility to infection.

Additional Resources

1. Lagarde SM, Omloo JMT, de Jong K, Busch OR, Obertop H, van Lanschot JJ. Incidence and management of chyle leakage after esophagectomy. Ann Thorac Surg. 2005;80(2):449-454.
2. Tamura T, Kubo N, Yamamoto A, et al. Cervical chylous leakage following esophagectomy that was successfully treated by intranodal lipiodol lymphangiography: a case report. BMC Surg. 2017;17(1):20.