A systematic review of English and non-English articles using OVID MEDLINE (1980–2014) was performed to evaluate the potential value of prophylactic ligation of the thoracic duct in preventing chylous leakage after oesophagectomy for cancer. Search terms included [Oesophagectomy OR esophagectomy] AND [chylothorax] AND [thoracic duct ligation]. Only those papers that directly compared the incidence of chylothorax in patients who underwent prophylactic ligation [ligation group (LG)] with that in those who had conservative treatment were selected [preservation group (PG)]; all the articles presenting original data and supplying sufficient information on the chylothorax rate after oesophagectomy were included. Independent extraction of articles was performed by two authors using predefined data fields, including study quality indicators. The PRISMA guidelines were carefully adhered to. A total of 5254 subjects were included in the 7 clinical studies examined into the current meta-analysis. Of these, 2179 patients underwent prophylactic ligature of the thoracic duct (LG group) and 3075 had preservation of the thoracic duct (PG group). A significant difference in terms of chylothorax rate [odd ratios (ORs) 0.47 in favour of LG, 95% confidence interval (CI) 0.27–0.80] was noted between the LG group and the PG group. According to our meta-analysis and taking into account-specific caveats, prophylactic ligation of the thoracic duct could be considered as an effective preventative measure to reduce the incidence of postoperative chylothorax.

Background & Aims: The ultrasound‐based controlled attenuation parameter (CAP) is a non‐invasive tool widely validated for assessing liver steatosis across different etiologies. However, few studies, with liver biopsy available, have investigated its performance in individuals with morbid obesity. Herein, we aimed to evaluate the diagnostic accuracy of CAP in participants with morbid obesity from the MAFALDA study before bariatric surgery.Methods: A total of 120 individuals with valid examinations within three months from bariatric surgery were included. Clinical, laboratory, FibroScan^® (XL probe), and liver biopsy data were collected using standardized procedures. The overall accuracy of CAP for detecting liver steatosis was estimated by the area under the receiver‐operating characteristics curve (AUROC). Optimal cut‐offs were chosen at points with the highest Youden index.Results: The AUROCs of CAP for detecting S ≥ S1, S ≥ S2, and S = S3 were 0.91 (95% CI 0.86–0.97), 0.83 (95% CI 0.76–0.90), and 0.86 (95% CI 0.79–0.94), respectively. The best CAP cut‐offs for S ≥ S1, S ≥ S2, and S = S3 were 300 dB/m (95% CI 275–316), 328 dB/m (95% CI 296–345), and 344 dB/m (95% CI 343–352), respectively. CAP values were independently influenced by steatosis grade (estimate 20.60, 95% CI 12.70–28.40, P = 1.05 × 10⁻⁶). The AUROC of FibroScan‐AST (FAST) score for detecting progressive non‐alcoholic steatohepatitis was 0.76 (95% CI 0.66–0.86).Conclusions: In individuals with morbid obesity, CAP measured by XL probe is an accurate non‐invasive tool for grading liver steatosis. Measurement of liver fat content by CAP may help identify those eligible for bariatric procedures and estimate the effect of bariatric surgery on hepatic steatosis.Lay Summary: The ultrasound‐based controlled attenuation parameter (CAP) by using the XL probe has an excellent performance for grading liver steatosis among individuals with morbid obesity.CAP may represent an accurate tool for the non‐invasive assessment of liver steatosis among individuals with morbid obesity before and after bariatric surgery.