Systematic approach to the treatment of chylous leakage after neck dissection

• Published in: Head & neck Vol. 18; no. 4; pp. 347 - 351
• Main Authors: de Gier, Henriëtte H. W., Balm, Alfonsus J. M., Bruning, Peter F., Gregor, R. Theo, Hilgers, Frans J. M.
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01-07-1996; John Wiley & Sons
• Subjects: Adult; Aged; Biological and medical sciences; Chyle; Diet Therapy; Drainage; Female; Fistula - etiology; Fistula - therapy; Head and Neck Neoplasms - surgery; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Male; Medical sciences; Middle Aged; Neck - surgery; Neck Dissection - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Thoracic Duct - injuries; Human; Effusion; Respiratory disease; Male; Drainage; Prevention; Treatment; Surgery; Adolescent; Pleural disease; Adult; Complication; Female; Neck; Dissection; Elderly; Chylothorax
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/(SICI)1097-0347(199607/08)18:4<347::AID-HED6>3.0.CO;2-Y

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 right‐sided 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 (TissucolR).
Conclusions
Chylous leakage is a controllable complication after neck dissection for which in most cases a stepwise conservative approach consisting of dietary modifications, maintaining closed vacuum suction drainage, seems to be sufficient. Hematologic and serum values should be monitored very carefully and corrected appropriately. To initiate planned postoperative radiotherapy in a timely fashion, the conservative treatment should be limited to about 30 days. HEAD & NECK 1996;18:347–351 © 1996 John Wiley & Sons, Inc.