Conservative Management of Postoperative Chyle Fistulas

Abstract

Objectives: 1) Describe our experience in the diagnosis and conservative treatment of postoperative chyle fistulas. 2) Introduce a protocol of conservative treatment based on the volume of the chyle drainage. Methods: Over the last 10 year period, 354 neck dissections were performed in our department. Of the 354 patients, 11 (3,1%) developed postoperatively chyle leakage confirmed by biochemical analysis of the drain output. All 11 patients were managed conservatively. Treatment varied according to the volume of drain output. Patients with mean chyle leakage less than 300cc/day (7 patients) were treated with low fat diet and oral nutrition with medium chain triglycerides (MCT). In four cases, the volume of the chyle was over 300cc/day and was adequately managed with combination of total parenteral nutrition (TPN) and somatostatine. Among them, there was a single case that developed an excessive chylous drain output (3100cc) on the third postoperative day after introduction to oral feeding and was also treated conservatively with TPN and subcutaneous administration of somatostatine. Results: None of the patients required surgical intervention. In all patients the amount of chyle decreased after the first day of somatostatine implementation and was resolved successfully in the next three to six days respective to the amount. Conclusions: Conservative management based on the volume of chyle output by means of either combination of low fat diet and MCT oral intake, or combination TPN and somatostatine, may be an efficient treatment in patients with chyle fistulas.