The management of chyle fistula

Abstract

Over a recent 4-year period, 823 neck dissections that included the lower jugular lymph nodes were performed. Of the 823, 14 (1.9%) patients developed chyle fistulas. Two other patients developed fistulas, one after undergoing a gastric transposition, and the other after a scalene node biopsy. All 16 patients were initially managed conservatively with closed-wound drainage and low-fat nutritional support; this was successful in only 4 patients, 3 of whom had peak 24-hour chyle drainage of less than 600 cc. The remaining 10 patients required open-wound management, which included operative ligation in 4 instances. Continued conservative treatment with an open neck wound resulted in significant additional hospitalization. Our experience indicates that closed-wound management of a chyle fistula is likely to fail when peak 24-hour fistula output exceeds 600 cc. Considering the cost and morbidity of conservative treatment, early reoperation may be appropriate in those patients with high fistula output.

Negative Pressure Wound Therapy in the Treatment of Chylousfistula after Neck Dissection

“…Where a fragile duct suture is impossible, cellulose mesh, fibrin glue or muscle flaps (sternohyoid or sternocleidomastoideus) may be used in the fistula closure. For postoperative chyle leaks a conservative therapy is preferred [4,5] : bed rest, drainage, compression bandages, medium chain triglycerides diet, total parenteral nutrition. Low-output (<500 ml /24 h) fistulas tend to respond to conservative measures, whereas high-output secreting fistulas (>500 ml/24 h) are generally refractory and require surgical revision.…”

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

“…12 Immediate suture ligation should be done or hemoclips should be applied. 12 Intraoperatively under anesthesia leakproof ligation should be confirmed by manual hyperventilation.…”

“…12 Immediate suture ligation should be done or hemoclips should be applied. 12 Intraoperatively under anesthesia leakproof ligation should be confirmed by manual hyperventilation. 13 Postoperative chyle fistula will be manifested by increasing output of milky fluid and most of them are managed conservatively and rarely need reexploration.…”