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Systematic approach to the treatment of chylous leakage after neck dissection

✍ Scribed by Henriëtte H. W. de Gier; Alfonsus J. M. Balm; Peter F. Bruning; R. Theo Gregor; Frans J. M. Hilgers

Publisher: John Wiley and Sons
Year: 1996
Tongue: English
Weight: 405 KB
Volume: 18
Category: Article
ISSN: 1043-3074
DOI: 10.1002/(sici)1097-0347(199607/08)18:4<347::aid-hed6>3.0.co;2-y

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✦ Synopsis

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 rightsided 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 (TissucoP).

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