Chylous Fistula: Complication of Neck Dissection

Fitz‐Hugh, G. Slaughter; Cowgill, Robert

doi:10.1001/archotol.1970.00770040773010

Cited by 68 publications

(23 citation statements)

References 8 publications

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“…Incidence in the literature is reported to be less than 1%, with consideration of lymphonodal dissection up to 2.5% [1][2][3][4]. Recognized risk factors for development of lymph fistulas are lymphonodal neck dissection, particularly in the lateral compartment of the cervical neck and prior oncologic irradiation to the neck [5].…”

Section: Introductionmentioning

confidence: 99%

Management of lymph fistulas in thyroid surgery

Lorenz

Abuazab

Sekulla

et al. 2010

Langenbecks Arch Surg

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Data of this series support definition of the two categories of high- and low-output fistulas according to drainage collection with >300 versus <200 ml/day. Fasting in low-output fistula facilitates conservative treatment with closed drainage, whereas in high-output fistulas surgical intervention should be sought. Attendant criteria for treatment stratification are equally important, like patient's compliance, nutritional, and general health status as well as evidence for wound infection. Surgical closure of lymph fistula may be demanding when identification of the secreting fistula is limited and even muscle flap fortification may fail. Ultimately, in unsuccessfully reoperated fistula recurrences, open drainage may become necessary. Lymph fistulas cause significantly prolonged hospital stay, possible critical clinical decay, and unfavorable cosmetic and oncologic outcome while the superior management remains to be defined.

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Section: Introductionmentioning

confidence: 99%

Management of lymph fistulas in thyroid surgery

Lorenz

Abuazab

Sekulla

et al. 2010

Langenbecks Arch Surg

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“…Chylous fistula, secondary to thoracic duct injury, has been known to be a potential complication of neck surgery since the 19th century 1,2 . The incidence of chylous fistula as a complication of neck dissection has been consistently reported by several authors 3‐8,11 to be between 1% to 3%, with a predominance of cases being encountered with the dissections of the left neck. In recent years, authors on the subject of chylous fistula management agree that the first precept of management is that of primary prevention of duct injury 4‐8 .…”

Section: Discussionmentioning

confidence: 95%

“…When thoracic duct injuries and resulting chylous leaks are encountered during surgery, most authors 4‐8 recommend that immediate intraoperative repair be attempted, as it was in the case presented. There are several methods of successful surgical repair of chylous fistulae that have been described in the literature, including direct ligation of the thoracic duct, 5,7,11 oversewing the leak with fascia 11 or muscle flaps, 3,6,8 or even using fibrin glue 3,8 . In many cases, intraoperative repair, along with careful inspection for subsequent leakage (enhanced with Valsalva's maneuver provided by anesthesia), is all that is needed to successfully manage this complication.…”

Section: Discussionmentioning

confidence: 99%

“…However, when postoperative chylous leaks are encountered, there are conservative, nonoperative measures that, if implemented promptly, have been found to be very successful 3‐8,11 . These include bedrest, fat‐free or mediumchain triglyceride diet (by which 6‐ to 12‐carbon‐chain fatty acids are directly absorbed by the portal circulation, bypassing the chyle), 12 hyperalimentation, pressure dressings, and tetracycline sclerotherapy 13 .…”

Section: Discussionmentioning

confidence: 99%

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Repair of a High‐Output Chylous Fistula With a Free Fat Graft

Casler

Brietzke

1998

The Laryngoscope

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“…Chylous fistula has been described after several surgical procedures, especially in the region of the neck and thorax (Fitz-Hugh and Cowgill, 1970;Merrigan et al, 1997). Chylous fistula after a modified radical mastectomy, however, is a rare occurrence.…”

Section: Introductionmentioning

confidence: 99%

Post‐mastectomy chylous fistula: Anatomical and clinical implications

et al. 2004

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A chylous fistula after a modified radical mastectomy is a rare occurrence; however, major anatomical variations in the termination of the thoracic duct may occur, rendering it susceptible to injury. High output chylous fistulae are difficult to manage and have local, metabolic, and immunologic complications with a mortality rate varying from 12.5-50%. Herein such a case of postmastectomy chylous fistula and its management are discussed. A 56-year-old postmenopausal woman with invasive duct carcinoma of the left breast underwent modified radical mastectomy with complete axillary clearance (Level I, II, III nodes). The operative procedure was uneventful. On the commencement of a normal diet, however, the patient started exuding milky fluid from the axillary drain and analysis of the fluid revealed biochemical features compatible with chyle. After 2 weeks of failed conservative management, the axilla was re-explored. A continuous flow of clear fluid was observed originating from a single major lymphatic trunk inferior to the axillary vein in the region of the former Level II nodes. The leak was controlled by the application of multiple mass ligatures using 2-0 silk suture. A part of the pectoralis major muscle was rotated and sutured over the area of the leak as additional reinforcement. Suturing a muscle flap over the leak has been described previously and functions theoretically by causing fibrosis. The chylous fistula in the present case was managed successfully with mass ligatures and muscle flap reinforcement.

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Chylous Fistula: Complication of Neck Dissection

Cited by 68 publications

References 8 publications

Management of lymph fistulas in thyroid surgery

Management of lymph fistulas in thyroid surgery

Repair of a High‐Output Chylous Fistula With a Free Fat Graft

Post‐mastectomy chylous fistula: Anatomical and clinical implications

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