Postoperative Chyle Leaks in Abdominal Surgery: Contemporary Management Strategies and Emerging Surgical Innovations

Background: Postoperative chyle leaks, although rare, present significant clinical challenges following abdominal and retroperitoneal surgeries. These leaks can lead to substantial nutritional, immunologic and metabolic complications if not promptly recognised and treated. The fragmented nature of existing literature and the lack of standardised protocols further complicate management. Objective: To provide a comprehensive, evidence-based review of postoperative chyle leaks in abdominal surgery, consolidating current diagnostic approaches, volume-based grading systems, therapeutic strategies and recent technological advancements from 2015 to 2025. Methods: A structured review of PubMed-indexed literature was performed, incorporating systematic reviews, meta-analyses, randomised controlled trials and consensus recommendations relevant to the surgical management of chyle leaks. Emphasis was placed on diagnostic criteria, classification systems, conservative management pathways, image-guided interventions and surgical techniques, as well as emerging modalities. Results: Diagnosis relies on a high clinical suspicion and confirmation by characteristic biochemical findings (e.g., triglyceride >110 mg/dL in drain fluid) supported by imaging modalities such as magnetic resonance lymphangiography (MRL). Volume-based stratification into low-output and high-output leaks aids in guiding therapy. Conservative measures, including medium-chain triglyceride (MCT)-based nutrition, somatostatin analogues and parenteral support are effective in most cases. High-output or refractory leaks may necessitate lymphangiographic embolisation or surgical ligation. Emerging tools such as intraoperative indocyanine green (ICG)-guided lymphatic mapping, nano sealants and artificial intelligence (AI)-based leak prediction are reshaping clinical paradigms. Conclusion: An algorithmic, volume-based, multidisciplinary approach is essential for optimal outcomes in managing postoperative chyle leaks. With technological advances and improved imaging, management is evolving toward precision-guided intervention. However, a global consensus on classification, treatment thresholds and prospective outcome data remains urgently needed.