Management Of Chylous Fistula Research Articles

Tetracycline Sclerotherapy in the Management of Chyle Leak

ABSTRACT Chyle leak following neck dissection is a rare but recognized complication with significant morbidity. The timing, indications and treatment modalities of chylous fistula remain controversial. Sclerotherapy using tetracycline is not a much acclaimed form of treatment in the management of chylous fistula. We report a case of postoperative chylous leak successfully managed by injection of tetracycline into the supraclavicular wound bed. How to cite this article Singh M, Vijayanand S, Amit B, Raman R, Narahari R. Tetracycline Sclerotherapy in the Management of Chyle Leak. J Health Sci Res 2015;6(1):14-16.

The Role of Somatostatin Treatment in the Management of Chylous Fistula after Neck Dissection

Chylous fistula is a serious complication of neck dissection. The use of somatostatin after neck surgery, has been described in literature. Because of the absence of definitive guidelines, reporting of our experience in three cases may guide the surgeons to overcome this life threatening complication. We descibe three cases who underwent neck dissection. While two of them had high output (>1000 mL/day), one had a low output (250 mL/ day) chyle leakage, after neck dissection. After it was noticed in earlier days, conservative management was started immediately. While Somatostatin was started after the re-exploration in two, it was started due to the failure of conservative treatment for low output leakage in one. All of the chyleous fistulas were healed within less than two weeks. We think that somatostatin may be considered as an effective treatment in low output chyle fistulas which the leakage continues after conservative treatment; however in high output chyle fistulas, somatostatin should be used in patients due to lack of control of leakage after ligation of thoracic ductus in revision Somatostatin treatment was discussed in the light of the current literature.

頸部郭清術後リンパ漏の検討

2001年から2011年までの11年間に，当科で頸部郭清術を行った症例は352例，471側であった。そのうち18例（3.8%）に術後リンパ漏を認めた。患側は，右3例，左15例であった。原発部位別に検討すると，甲状腺8例，喉頭4例，下咽頭3例，中咽頭・口腔・顔面皮膚が1例ずつであった。発症までの日数は平均2.2日（1～7日）であった。最大1日排液量は平均412ml（81～1400ml）であった。治癒に要した期間（初回手術日からリンパ漏が消失するまでの日数）は平均20.5日（5～82日）であった。保存的加療で治癒したものが14例，ミノサイクリン局所注入療法おこなった症例が2例，再手術を行った症例が2例あった。合併症として3例に局所感染を認めた。

Chylous Fistula After Axillary Lymph Node Dissection: Incidence, Management, and Possible Cause

Introduction Chylous fistula is a known complication in procedures such as neck dissection and aneurysm surgery. However chyle leak that develops after axillary dissection is a rare phenomenon. In this study we have evaluated the incidence, possible cause, and management of chylous fistula that develops after radical breast cancer surgeries. Material and Methods Chylous fistula developed in 6 of 1863 patients who underwent axillary dissection. Their records were analyzed in terms of clinical profile and management. A review of the literature regarding the thoracic duct anatomy at its termination was carried out and a hypothesis about the possible cause of chylous leak was suggested. Results All 6 patients had procedures on the left side and had varied clinical stages and profiles. The chyle discharge was detected intraoperatively during the primary surgical procedure in 2 patients. The other 4 patients presented with chyle in their drains postoperatively. One patient did not respond to conservative management and underwent reexploration to seal the leak. Injury to the thoracic duct or its aberrant branches is apparently not the cause of chylous fistula in the axilla. The injury to the left subclavian duct or its tributary, which drains aberrantly into the thoracic duct through a valveless junction has been hypothesized to be the source of chyle in the axilla. Conclusion Chylous fistula is very unusual after axillary dissection. Most of the chyle leaks in the axilla are manageable through conservative methods; surgical intervention is required rarely in special situations. Injury to the left subclavian duct or its tributary is the possible cause.

Management of chylous fistula as a complication of neck dissection: a 10-year retrospective review

Chylous fistula is a serious complication of neck surgery. The aim of this study was to analyse the incidence, treatment and evolution of chylous fistula in neck dissection. We conducted a retrospective study of 304 patients, 295 (97.03%) men and nine (2.97%) women. Ages ranged from 24 to 80 years (mean = 59.28 years, SD = 6.02) and they had all undergone neck dissection. Chylous fistula occurred in four cases (1.31%). Incidence was 1.83% in laryngeal cancer and 2.7% in oral cavity and oropharyngeal cancer. No statistically significant correlation was found between tumoral stage and fistula occurrence. Radiotherapy prior to surgery was a risk factor although the association was not statistically significant. The incidence rates for radical and functional neck dissection were 3.3% and 0.46%, respectively, statistically significant (P = 0.042). The fistulas were located on the left side in all cases. One of the four patients required surgical intervention and another one died. The occurrence of chylous fistula increased significantly the length of hospital stay (P = 0.01). Chylous fistulas appear on the left side, radiotherapy prior to surgery is a risk factor and there is not correlation with tumoral stage. Chylous fistulas are significantly more common in radical than in functional dissections and increase significantly the length of hospital stay.