CPT® Code 38382

1. Indications

The procedure is indicated for the following conditions:

• Lymphatic Leak - This procedure is performed when there is a suspected or confirmed leak in the thoracic duct, which can occur due to surgical trauma, injury, or other pathological conditions.
• Thoracic Duct Injury - Surgical intervention is necessary when the thoracic duct has been compromised, leading to lymphatic fluid accumulation and potential complications.
• Management of Chylothorax - This procedure may be indicated in cases of chylothorax, where lymphatic fluid accumulates in the pleural cavity, often requiring surgical correction to prevent further fluid buildup.

2. Procedure

The procedure involves several critical steps to ensure effective repair of the thoracic duct:

• Incision - An incision is made in the upper abdomen to access the thoracic duct. This incision allows the surgeon to open the peritoneal cavity and gain visibility of the surrounding structures.
• Opening the Peritoneal Cavity - The peritoneal cavity is opened, and the falciform ligament is divided to facilitate access to the thoracic duct. This step is crucial for mobilizing the liver and providing a clear view of the duct.
• Liver Mobilization - The liver is carefully mobilized and retracted to expose the thoracic duct adequately. This maneuver is essential for preventing damage to the liver and ensuring a safe working environment for the surgeon.
• Diaphragm Incision (if necessary) - Depending on the location of the thoracic duct leak, the diaphragm may need to be incised to enter the mediastinum. This step allows the surgeon to access the thoracic duct directly and locate the site of the injury.
• Repair of the Leak - Once the site of the leak is identified, the surgeon repairs the injury using sutures or ligation techniques. This may involve tying off the duct a few centimeters above and below the leak to prevent further lymphatic fluid escape.
• Placement of Chest Tubes - Following the repair, chest tubes are placed to facilitate drainage of any residual fluid and to monitor for ongoing leaks. This is a critical step in ensuring proper recovery and preventing complications.

3. Post-Procedure

After the procedure, the patient is monitored for any signs of continuing leakage from the thoracic duct. A dry gauze pad is placed over the repaired area to absorb any lymphatic fluid that may escape. The gauze is periodically checked and removed once it is determined that there is no ongoing leakage. Additionally, the repair may be reinforced with a spray or glue-type sealant to enhance closure and prevent future leaks. The patient will be observed for recovery from anesthesia and any potential complications related to the procedure, including infection or fluid accumulation. Follow-up imaging may be required to ensure the integrity of the repair and the absence of further leaks.