Operative management for refractory chyle leakage after pancreatectomy: A case report and literature review

Post-pancreatectomy chyle leak is a common complication typically managed conservatively. However, rare ISGPS grade C leaks that produce high output can lead to significant morbidity and often resist non-operative treatments. We report two cases of such refractory leaks successfully addressed through surgical intervention. We describe two complex cases of postoperative chyle leakage. The first case involves a 66-year-old female who underwent pylorus-preserving pancreaticoduodenectomy with portal vein resection. The second case is a 67-year-old female who underwent completion total pancreatectomy. Both patients experienced persistent, high-output chyle leakage that did not respond to conservative management and several interventional procedures. Ultimately, both were successfully treated with exploratory laparotomy and multiple lymphatic ligations after undergoing preoperative fat loading. Postoperative chyle leak is initially managed conservatively, with interventional options reserved for refractory cases, though these are often ineffective. When conservative measures fail, surgical management with fat loading, targeted or prophylactic lymphatic ligation, and adjunct sealants can provide lasting control. Surgical management presents a viable salvage strategy for refractory postoperative chyle leaks when nonoperative measures are ineffective. Preoperative fat loading aids in intraoperative localization. Timely surgical intervention can prevent malnutrition and preserve opportunities for adjuvant therapy.