Management of lymph fistulas in thyroid surgery

Abstract

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.

Chyle Fistula After Neck Dissection: An 8-Year, Single-Center, Prospective Study of Incidence, Clinical Features, and Treatment

“…3,4,8 However, the majority of studies supporting the effectiveness of octreotide was limited to a single case or a series of low-output chyle fistula cases. 3,[8][9][10] By analyzing our 8-year experience with chyle fistula after neck dissection, we aimed to evaluate its true incidence, risk factors, and clinical course. The outcomes of conventional management and the use of octreotide injection as a new therapeutic option in high-output chyle fistula were also investigated.…”

Single port thoracoscopic treatment of thoracic duct injury after thyroidectomy with neck dissection

“…Even though, ligation of ductus thoracicus can be performed by open thoracotomy technique, successful treatment of chyle fistula has been recently demonstrated with thoracoscopic approach. This procedure is effective and avoids the significant morbidity of major thoracic access (3,10). Usually, right-sided approach is preferred for identification of ductus thoracicus.…”

“…Due to left side prominent termination of thoracic duct, these injuries occur predominantly on the left side of patients underwent to lateral neck dissection (1). Chylous fistulas occur between the first and third postoperative day in 86% of patients (1,3).…”

“…Initial management of chylous fistula begins with dietary modifications such as diets poor in fat with medium chain triglycerides or total parenteral nutrition, repeated drainage, pressured dressings (2,4). In addition, recent studies demonstrated that somatostatin and its analogues have high effectiveness in management of chylous fistulas, with less side effects (2,3).…”

Surgical endocrinology—update 2010

“…Low-output fistula justifies conservative treatment (fasting, parenteral nutrition) whereas high-output fistulas longs for surgical intervention (ligation, suture, muscle flap, fibrin glue, hemostyptic fleece-combination of two or more). Lymph fistulas cause significantly prolonged hospital stay, possible critical clinical decay and unfavourable cosmetic and oncologic outcome ( [15] Langenbecks Arch Surg, this issue).…”