Systematic approach to the treatment of chylous leakage after neck dissection

Abstract

Background Chylous leakage is an uncommon complication after neck dissection for which several treatment modalities have been described in literature. It occurs in 1% to 2.5% of radical neck dissections, with the majority (75% to 92%) being on the left side. In a consecutive series of patients, we investigated the effect of a systematic approach to the complication. Methods Over a period of 5 years, the drain production of 221 patients who underwent a neck dissection was analyzed. One hundred thirty‐two right‐sided and 139 left‐sided neck dissections were performed. In 11 patients a chyle fistula occurred, 1 right‐sided and 10 left‐sided. In all cases closed vacuum suction drainage was continued and dietary modifications (medium‐chain triglycerides [MCT]/PeptisonR nasogastric tube feeding [PNTF]) were made. Results In 5 patients dietary modifications were sufficient to stop the leak. In the other 6 patients total parenteral nutrition via the subclavian vein (TPN) was started. In 2 cases with a severe intractable hypoalbuminemia, surgical intervention was necessary. The leak was closed by a pectoralis major muscle flap transfer, after local application of fibrin sealant (TissucolR). Conclusions Chylous leakage is a controllable complication after neck dissection for which in most cases a stepwise conservative approach consisting of dietary modifications, maintaining closed vacuum suction drainage, seems to be sufficient. Hematologic and serum values should be monitored very carefully and corrected appropriately. To initiate planned postoperative radiotherapy in a timely fashion, the conservative treatment should be limited to about 30 days. HEAD & NECK 1996;18:347–351 © 1996 John Wiley & Sons, Inc.

Abdominal chyloma: Computed tomography findings

“…Chyloma is a rare clinical entity that occurs secondary to obstruction of lymphatic flow or leakage from lymphangiectatic vessels, which can be secondary to surgery (1). Herein, we present the computed tomography (CT) findings of this challenging diagnosis in an abdominal chyloma patient with left adrenalectomy.…”

Biometric measurements involving the terminal portion of the thoracic duct on left level IV: an anatomic study

“…During a neck dissection involving level IV on the left side, there is a risk of injury of this important lymphatic vessel at its final segment, before entering the venous system. Albeit infrequent, being reported in 1-3% of the cases [3][4][5][6][7][8][9][10][11][12][13] , this complication may bring significant postoperative morbidity causing a prolonged time of hospitalization. This represents higher therapy-related costs and even higher risks for the patient's health.…”

Crushed Muscle Tissue Graft: A Efficient Repair Technique for Intraoperative Chylous Fistulas

“…[1][2][3][4] The various modifications of neck dissections are aimed at blocking tumor cell migration and metastasis into the lymphatic drainage system. 5 Careful preservation of vital structures like carotid artery, vagus nerve, thoracic duct, and phrenic nerve takes the top priority in neck dissections.…”

“…20 Large leaks cause dehydration, leading to hypoalbuminemia with edema. 3 Blood collection in the drains and flap swelling delay the identification of chyle leak, while milky-like collection raise the suspicion. 5 The content of the drainage can be tested by switching the patient to a low-fat diet where in chyle leakage rapid clearance is seen.…”

“…7 Total parenteral feeding should be begun when the total volume of the chylous leakage exceeds 1,000 ml on postoperative day 3 dramatically decreases the chyle volume. [1][2][3]8 Serum albumin and electrolytes should be regularly followed up. 5 The TPN can be discontinued after the closed drainage volume decreases to <10 ml/day.…”