Systematic management of chyle fistula: The Southwestern experience and review of the literature

Postoperative cervical chyle fistula after neck dissection is a complication with potentially serious morbidity. Once it is recognized, treatment decisions to optimize patient care can be difficult. Different management strategies have been advocated on the basis of institutional and personal experi...

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Bibliographic Details
Published in:Otolaryngology-head and neck surgery 2000, Vol.122 (1), p.31-38
Main Authors: NUSSENBAUM, BRIAN, LIU, JAMES H., SINARD, ROBERT J.
Format: Article
Language:English
Subjects:
Adult
Aged
Chyle
Female
Fistula - etiology
Fistula - therapy
Humans
Intraoperative Complications - therapy
Lymphatic Diseases - therapy
Male
Middle Aged
Neck - surgery
Neck Dissection - adverse effects
Retrospective Studies
Thoracic Duct - injuries
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Summary:Postoperative cervical chyle fistula after neck dissection is a complication with potentially serious morbidity. Once it is recognized, treatment decisions to optimize patient care can be difficult. Different management strategies have been advocated on the basis of institutional and personal experience. In this study we comprehensively review the published protocols and retrospectively review our experience in the management of 15 patients with chyle fistula. All patients in this study were given a trial of nonoperative management with nutritional modification, pressure dressings, and closed drainage. Medical management ultimately failed in 3 patients (20%). Two patients had prolonged courses of medical management with associated complications. An analysis of our data supports early operative intervention if the peak 24-hour drainage is greater than 1000 mL without a prompt response to medical management. Persistent low-output drainage after 10 days is associated with a prolonged management course and treatment-related complications. Optimal treatment of these patients is unclear. (Otolaryngol Head Neck Surg 2000;122:31-8.)
ISSN:0194-5998
1097-6817
DOI:10.1016/S0194-5998(00)70140-9