P20 MINIMALLY INVASIVE TRATMENT OF CHYLE LEAK AFTER ESOPHAGECTOMY USING INDOCYANINE GREEN (ICG) ENHANCED FLUORESCENCE

Background Chyle leak is a rare but life-threatening complication after esophagectomy. In Literature is reported a mortality rate up to 40% in case chyle leak after esophageal surgery. In case of re-operation, ligature of the chyle duct is mandatory. However, chyle duct identification can be difficult. To our knowledge, in Literature are reported only two cases of chyle duct identification through ICG visualization. We present the case of a 66 years old male patient who underwent to a totally mini-invasive McKeown esophagectomy for a locally advanced esophageal adenocarcinoma, after neoadjuvant chemo-radiotherapy. In 2nd post-operative day (POD) we observed a chylous debt from the thoracic drain, sign of chyle leak. A first conservative approach was tempted, with a nihil-per-os regimen and total parenteral nutrition, with a significant reduction in drain output. However, at the resumption of oral intake, we observed a new increase of drain output. We therefore decided to re-operate the patient to seal the leak. On POD 15 the patient was submitted to a new thoracoscopy, with previous inguinal green indocyanine infiltration. During the thoracoscopy, the ICG allowed to safely identify the chyle duct and to proceed to its selective ligation. During the following days the patient’s clinical state progressively improved, allowing to restore oral feeding in POD3. No chyle debt was attested from the drainage, removed in POD 5. The patients was dismissed the next day. In our opinion, this is a promising application for the ICG technique.