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The thoracic duct is essential for lymphatic drainage but can exhibit anatomical variations that complicate surgical procedures, particularly in the neck, chest, and abdomen. These variations include multiple origins, additional branches, atypical courses, and bifurcations. Such variations increase the risk of thoracic duct injury and chylothorax, a condition where lymph leaks into the pleural space. This review discusses the clinical implications of these variations in lymphatic surgery, emphasizing the importance of preoperative imaging, precise surgical techniques, and prompt management of chylothorax. Understanding these variations is critical for minimizing complications and improving surgical outcomes.
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