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Gupta V, Dwivedi G, Chugh R, Sahu PK, Gupta DK, Basu A, Upadhyay K, Patnaik U, Bhatia R. Role of Octreotide in Conservative Management of Chyle Leak Post Neck Dissection in Cases of Head Neck Cancer: A Retrospective Analysis. Indian J Otolaryngol Head Neck Surg 2022; 74:6078-6086. [PMID: 36742480 PMCID: PMC9895617 DOI: 10.1007/s12070-021-02746-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
Chyle leak is a dreadful complication in patients undergoing neck dissections. Octreotide has been used in the management of chyle leak post neck dissections in head and neck cancer patients. Currently there is no consensus and practice guidelines on the same. (1) To study the role of octreotide in early cessation of post neck dissection chyle leak. (2) To study incidence of intra-operative and post-operative CL, its relation to the extent of nodal disease and neck dissection, prior radiotherapy. Retrospective analysis of 16 patients out of 529 neck dissection over a period of 03 years between Jan 2016 and Dec 2019 who developed post-operative chyle leak. All patients who had post-operative chyle leak were administered octreotide. Time taken for chyle leak to stop was primary outcome. Secondary outcomes were duration of hospitalization post-operatively, incidence of intra-operative and post-operative chyle leak, its relation to the extent of nodal disease, prior radiotherapy and type of neck dissection. 59 of 529 neck dissections (11.15%) were noted to have intra-operative chyle leak. 16 of 529 neck dissections (3.02%) developed post-operative chyle leak. On applying chi square test, prior multimodality and N plus neck were found to be significant risk factors in developing postoperative chyle leak. Considering only RT versus no RT in prior multimodality treated group, the difference was insignificant. Onset of chyle leak varied from 1 to 5 post-op day (mean 2.68 days). 15 (93.75%) patients responded to octreotide. Chyle leak resolved between 3 and 10 days (mean 5.18 days) and octreotide was given for 5-12 days (mean-7.18 days). Overall duration of hospitalization ranged from 09 to 18 days (mean 12.18 days). 01 patient (6.25%) had to be re-explored due to high volume leak despite using octreotide. Adverse effects of octreotide were minimal and tolerable. Octreotide is effective in reducing the duration of chyle leak, hospital stay and need for surgical intervention. It may be considered as suitable adjunct to conservative measures in the management for post-operative chyle leak.
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Affiliation(s)
- Vikas Gupta
- Department of ORL-HNS, Command Hospital, Lucknow, Uttar Pradesh India
| | - Gunjan Dwivedi
- Department of ORL-HNS, Command Hospital, Pune, Maharashtra India
| | - Rajeev Chugh
- Department of ORL-HNS, Army Hospital (Research and Referral), New Delhi, India
| | | | | | - Abhijit Basu
- Department of ORL-HNS, Command Hospital, Lucknow, Uttar Pradesh India
| | - Kiran Upadhyay
- Department of ORL-HNS, Command Hospital, Lucknow, Uttar Pradesh India
| | - Uma Patnaik
- Department of ORL-HNS, Command Hospital, Pune, Maharashtra India
| | - Ritika Bhatia
- Department of ORL-HNS, Command Hospital, Lucknow, Uttar Pradesh India
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Pan H, Jin P, Cao J, Yang Y. Neck swelling 19 days after thyroidectomy: A case report of a rare chyle leak patient. EAR, NOSE & THROAT JOURNAL 2022:1455613221121495. [PMID: 36041814 DOI: 10.1177/01455613221121495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The occurrence of chyle leak after neck dissection for thyroid carcinoma is uncommon, but it usually occurs within 1-10 days after surgery. We encountered a 30-year-old patient with chyle leak 19 days after the operation for thyroid carcinoma. The initial symptom was swelling of the neck, which was quickly diagnosed as chyle leak by puncture. This report describes the patient's presentation and discusses the conservative management of this complication. We highlight that more attention should be given to chyle leak in high-risk patients, and stricter dietary management for these patients after surgery may avoid this complication. In addition, timely diagnosis and rapid implementation of various conservative treatment measures play an important role in patient recovery.
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Affiliation(s)
- Huili Pan
- Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Peile Jin
- Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jun Cao
- Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yan Yang
- Nursing Department, Zhejiang University School of Medicine Second Affiliated Hospital, Zhejiang University, Hangzhou, China
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3
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Management and prevention of brachial plexus injury caused by surgical suture of neck dissection induced chylous fistula. Am J Otolaryngol 2022; 43:103597. [PMID: 35987100 DOI: 10.1016/j.amjoto.2022.103597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The complication of brachial plexus injury (BPI) after surgical suture of chylous fistula caused by neck dissection is extremely rare. For the first time, we investigated the treatment and prevention strategy of BPI caused by surgical suture of neck dissection induced chylous fistula. METHODS Forty-two patients undergoing surgical suture of neck dissection induced chylous fistula were identified between January 2015 to March 2022 at a single tertiary academic center. All patients were divided into two groups, medial anterior scalene muscle (MASM) group (24 patients) and lateral anterior scalene muscle (LASM) group (18 patients), according to the location of fistula regarding scalene muscle described in the surgical records. The incidence of BPI between the two groups after surgical suture was summarized and compared. RESULTS There was significant difference in the incidence of different degrees of BPI between the two groups. In the MASM group, the incidence of BPI was 0 % (0/24), while in the LASM group, 6 cases suffered different degrees of BPI immediately after operation and the incidence of BPI was 33.3 % (6/18) (p < 0.05). The neurological function of all BPI cases recovered within 1-3 months after the suture was removed in time. CONCLUSION The incidence of BPI in patients of LASM group was significantly higher than that of MASM group. When suturing this kind of fistula, the depth of the needle should be properly controlled to avoid BPI. In case of BPI, the suture should be removed as soon as possible to promote the recovery of neurological function.
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Chen L, Lin L, Li L, Xie Z, He H, Lin C, Chen J, Lin A. Lymphatic leakage after pelvic lymphadenectomy for cervical cancer: a retrospective case-control study. BMC Cancer 2021; 21:1242. [PMID: 34794409 PMCID: PMC8603468 DOI: 10.1186/s12885-021-08984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aims to evaluate the clinical features and management of postoperative lymphatic leakage (PLL) in patients with cervical cancer who received pelvic lymphadenectomy. METHODS This retrospective study screened consecutive patients with cervical cancer (stage Ia2-IIb). RESULTS Among 3427 cases screened, 63 patients (1.8%) were diagnosed with PLL, which manifested as persistent abdominal drainage (42/63, 66.7%), chylous ascites (12/63, 19.0%) or vaginal drainage (9/63, 14.3%). Median time from surgery to onset of PLL was 6 days (range, 4-21 days). All cases resolved in a median 10 days (range, 3-56 days) after conservative treatment; although one case experienced recurrence of vaginal drainage after 26 days, this also resolved after conservative therapy. Multivariate analysis showed that two cycles of neoadjuvant chemotherapy (odds ratio [OR], 3.283; 95% confidence interval [95%CI], 1.289-8.360; P = 0.013), a decrease in hemoglobin level of ≥20 and < 30 g/L (OR, 6.175; 95%CI, 1.033-10.919; P = 0.046) or ≥ 30 g/L (OR, 8.467; 95%CI, 1.248-17.426; P = 0.029), and postoperative albumin level ≥ 30 and < 35 g/L (OR, 2.552; 95%CI, 1.112-5.857; P = 0.027) or < 30 g/L (OR, 5.517; 95%CI, 2.047-18.148; P = 0.012) were associated with PLL. CONCLUSION Neoadjuvant chemotherapy, postoperative anemia and postoperative hypoproteinemia are risk factors for PLL.
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Affiliation(s)
- Li Chen
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Liang Lin
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Ling Li
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Zuolian Xie
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Haixin He
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Cuibo Lin
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Jian Chen
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - An Lin
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China.
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Parmeggiani D, Gualtieri G, Terracciano G, Gambardella C, Parisi S, Brusciano L, Ruggiero R, Docimo L. Prolonged iatrogenic thoracic duct chylous fistula in Neck Surgery: conservative management or surgery? A Literature review. Scand J Surg 2021; 110:550-556. [PMID: 33423617 DOI: 10.1177/1457496920987076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Thoracic duct chylous fistula is a rare complication following neck surgery, especially for malignant disease. Despite its low incidence, it can be a life-threatening postoperative complication increasing the risk of infection, bleeding, hypovolemia, electrolyte imbalance, and malnutrition. Currently, the management of thoracic duct fistula is not standardized yet. It can range from conservative to surgical approaches, and even when surgery indication occurs, there is no unanimous agreement on timing and operative steps, so the surgical approach still remains mostly subjective, in accordance with clinical conditions of the patients and with surgeon's experience. AIMS The aim of the study was to search into Literature a common accepted behaviour in thoracic duct chylous fistula occurring. METHODS A literature review was carried out. Conservative treatments include fasting associated with total parental nutrition or low-fat diet, compressive dressings, and octreotide administration. If conservative treatment fails, in order to avoid dangerous consequences, functional repair of the thoracic duct injury with lymphovenous microanastomosis should be the preferred solution, rather than an approach that obliterates the thoracic duct or lymphatic-chylous pathways, such as thoracic duct embolization, therapeutic lymphangiography, and thoracic duct ligation. CONCLUSIONS In our experience, patients undergone thyroidectomy and neck dissection for thyroid-differentiated cancer, who report an unrecognized thoracic duct chylous fistula after surgery, must be treated via integrated conservative and surgical treatment. A literature review about thoracic duct chylous fistula following neck surgery, focusing on the current management and therapeutic approach, was furthermore carried out, in order to delineate the actual therapeutic options in case of thoracic duct chylous fistula occurrence.
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Affiliation(s)
- D Parmeggiani
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - G Gualtieri
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - G Terracciano
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - C Gambardella
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - S Parisi
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - L Brusciano
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - R Ruggiero
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - L Docimo
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
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6
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Fukushima S, Komune N, Kamizono K, Matsumoto N, Takaiwa K, Nakagawa T, Kadota H. Use of negative pressure wound therapy to treat a cochlear implant infection around the auricle: a case report. J Wound Care 2020; 29:568-571. [PMID: 33052790 DOI: 10.12968/jowc.2020.29.10.568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although negative pressure wound therapy (NPWT) is widely used, its application to the head and neck region remains challenging due to anatomical complexities. This report presents the case of a female patient presenting with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes, uncontrolled diabetes and severe bilateral sensorineural hearing loss. The patient had undergone cochlear implant surgery and five months later the wound was infected with methicillin-resistant Staphylococcus aureus (MRSA). NPWT was started shortly after removing the internal receiver and was stopped 11 days later. NPWT helped in controlling infection and led to a successful wound closure. In this case, NPWT was effective in treating infectious wounds around the auricle after cochlear implant surgery. Declaration of interest: The authors have no financial support for this article and no conflict of interest directly relevant to the content of this article.
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Affiliation(s)
- Seita Fukushima
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Japan.,Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kenichi Kamizono
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Japan.,Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Japan
| | - Nozomu Matsumoto
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kazutaka Takaiwa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Fukuoka University, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hideki Kadota
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Japan
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7
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Yang YH, Park SY, Kim DJ. Chyle Leakage after Esophageal Cancer Surgery. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:191-199. [PMID: 32793451 PMCID: PMC7409880 DOI: 10.5090/kjtcs.2020.53.4.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
Surgeons recommend dissecting lymph nodes in the thorax, abdomen, and neck during surgery for esophageal cancer because of the possibility of metastasis to the lymph nodes in those areas through the lymphatic plexus of the esophageal submucosal layer. Extensive lymph node dissection is essential for accurate staging and is thought to improve survival. However, it can result in several complications, including chyle leakage, which refers to continuous lymphatic fluid leakage and can occur in the thorax, abdomen, and neck. Malnutrition, fluid imbalance, and immune compromise may result from chyle leakage, which can be potentially life-threatening if it persists. Therefore, various treatment methods, including conservative treatment, pharmacological treatment such as octreotide infusion, and interventions such as thoracic duct embolization and surgical thoracic duct ligation, have been applied. In this article, the risk factors, diagnosis, and treatment methods of chyle leakage after esophagectomy are reviewed.
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Affiliation(s)
- Young Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
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8
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Pines G, Malka Yosef L, Lazar LO, Bar I, Schindel D. Negative-Pressure Vacuum Therapy for High-Output Chyle Leak Following Neck Dissection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:481-483. [PMID: 32628079 DOI: 10.1177/1556984520935535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chyle fistula is a challenging complication following neck dissection carrying a high morbidity and mortality rate. Herein we present a challenging case of successful management of high-output left-sided cervical chyle fistula with negative-pressure vacuum (VAC) therapy in a case where all conservative treatments failed. A 40-year-old man with lymphoma and supraglottic carcinoma underwent endoscopic resection and bilateral neck dissections. He developed high-output chyle fistula, nonresponsive to conservative treatments. Double-layered Vicryl mesh was placed between the sponge and the jugular vein to prevent vascular injury. Immediately after initiation of the VAC therapy, the output decreased, and completely stopped after 3 days. The VAC therapy was continued for additional 5 days to ensure complete seal of the fistula by granulation tissue, by which time the wound was primarily closed. VAC therapy seems to be a safe and effective treatment for high-output cervical chyle fistula following neck dissection, avoiding complex surgical interventions. Thoracic surgeons should be aware of this low-morbidity and potentially effective treatment modality for this challenging complication.
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Affiliation(s)
- Guy Pines
- 37601 Department of Thoracic Surgery, Kaplan Medical Center, Rehovot, Israel.,The Hebrew University Medical School, Jerusalem, Israel
| | - Liron Malka Yosef
- The Hebrew University Medical School, Jerusalem, Israel.,37601 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Li Or Lazar
- 37601 Department of Thoracic Surgery, Kaplan Medical Center, Rehovot, Israel.,The Hebrew University Medical School, Jerusalem, Israel
| | - Ilan Bar
- 37601 Department of Thoracic Surgery, Kaplan Medical Center, Rehovot, Israel.,The Hebrew University Medical School, Jerusalem, Israel
| | - Doron Schindel
- The Hebrew University Medical School, Jerusalem, Israel.,37601 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
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9
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The use of atropine in treatment of chylous fistula complicated by thyroid carcinoma surgery. Asian J Surg 2019; 43:369-371. [PMID: 31635934 DOI: 10.1016/j.asjsur.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/04/2019] [Indexed: 11/20/2022] Open
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10
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Chylous fistula: management of a rare complication following right anterior cervical spine approach. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:61-67. [PMID: 30820672 DOI: 10.1007/s00586-019-05929-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Chylorrhea resulting from injury of the lymphatic system during neck dissection is a well-known complication. It is an uncommon occurrence in spinal surgery, and only one case after right anterior cervical spine surgery has been described so far. Despite its rarity, chylous leakage deserves a particular attention since it may become a serious and occasionally fatal complication if not detected early and managed appropriately. METHODS We report the case of a 42-year-old man who underwent a standard anterior cervical discectomy and fusion according to Cloward approach for a C6-C7 disk herniation. The patient developed a delayed prevertebral chyle collection on postoperative day 5, presenting with mild breathing and swallowing difficulties. RESULTS He was managed with conservative care, including bed rest, low-fat diet and drainage pouch positioning, which led to the complete resolution of the fluid collection. CONCLUSIONS Knowledge of the normal anatomy of the lymphatic system and of its variations is essential when planning an anterior spinal procedure, and represents the first measure to be adopted in order to avoid such complication. The prompt identification of a postoperative chylous fistula and the applicability of an individually based management's protocol may help in the majority of the cases to reduce the potential morbidity, without significant long-term effects.
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11
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The Effect and Mechanism of Negative Pressure Wound Therapy on Lymphatic Leakage in Rabbits. J Surg Res 2019; 235:329-339. [DOI: 10.1016/j.jss.2018.09.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/04/2018] [Accepted: 09/20/2018] [Indexed: 01/30/2023]
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Abstract
The incidence of thyroid cancer is increasing, largely attributable to overdetection related to prevalent diagnostic and radiologic imaging modalities. Papillary thyroid cancer remains the most common thyroid malignancy. It has a high tendency for regional metastasis to the cervical lymph nodes. The optimal management of the neck in patients with thyroid carcinoma has long been an important topic of debate. This article addresses central and lateral neck dissection, providing a simplified guide to the most up-to-date and evidence-based practices.
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Affiliation(s)
- Ahmad M Eltelety
- Endocrine Head and Neck Surgery, Otolaryngology Department, Medical College of Georgia, Augusta University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA; Otolaryngology Department, Cairo University, ElManial, Cairo 11562, Arab Republic of Egypt
| | - David J Terris
- Otolaryngology Department, Augusta University, Thyroid and Parathyroid Center, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA.
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13
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Dorneden A, Olson G, Boyd N. Negative Pressure Wound Therapy (Wound VAC) in the Treatment of Chylous Fistula After Neck Dissection. Ann Otol Rhinol Laryngol 2019; 128:569-574. [PMID: 30693805 DOI: 10.1177/0003489419827037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Cervical chylous fistula is an uncommon but potentially severe occurrence associated with neck surgery. Methods for treating this problem have inconsistent efficacy and may result in lengthy hospital stays. Negative pressure wound therapy (NPWT) is a highly effective tool in the management of complex wounds. We report 3 cases where NPWT was successfully used to treat chylous fistulas following neck dissection. METHODS This is a retrospective chart review of 3 patients who developed chylous fistulas after neck dissection and were successfully treated with NPWT. RESULTS Chylous ouput ceased within 2 to 8 days of proper wound VAC placement. Hospital stays ranged from 6 to 47 days. Patients received altered diets, including TPN for 1 patient with high-flow output and nil-per-os (NPO) or clear liquids for the others. Patients received octreotide throughout their hospitalization. CONCLUSION NPWT shows potential as a treatment option for both high-volume and low-volume chylous fistulas following neck dissection.
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Affiliation(s)
- Ashley Dorneden
- 1 Department of Surgery, Otolaryngology Division, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Garth Olson
- 1 Department of Surgery, Otolaryngology Division, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Nathan Boyd
- 1 Department of Surgery, Otolaryngology Division, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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14
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Mir A, Guys N, Arianpour K, Svider PF, Rayess H, Zuliani G, Raza SN, Lin H. Negative Pressure Wound Therapy in the Head and Neck: An Evidence-Based Approach. Laryngoscope 2018; 129:671-683. [DOI: 10.1002/lary.27262] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/01/2018] [Accepted: 04/06/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Ahsan Mir
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
| | - Nicholas Guys
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
| | - Khashayar Arianpour
- Department of Otolaryngology-William Beaumont Hospital; Royal Oak Michigan U.S.A
| | - Peter F. Svider
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
| | - Hani Rayess
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
| | - Giancarlo Zuliani
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
- Division of Facial Plastic and Reconstructive Surgery; Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
- John Dingell VA Medical Center; Detroit Michigan U.S.A
| | - S. Naweed Raza
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
- Barbara Ann Karmanos Cancer Institute; Wayne State University School of Medicine; Detroit Michigan U.S.A
- John Dingell VA Medical Center; Detroit Michigan U.S.A
| | - Hosheng Lin
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University School of Medicine; Detroit Michigan U.S.A
- Barbara Ann Karmanos Cancer Institute; Wayne State University School of Medicine; Detroit Michigan U.S.A
- John Dingell VA Medical Center; Detroit Michigan U.S.A
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15
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Chan JY, Wong EW, Ng SK, van Hasselt CA, Vlantis AC. Conservative management of postoperative chylous fistula with octreotide and peripheral total parenteral nutrition. EAR, NOSE & THROAT JOURNAL 2018; 96:264-267. [PMID: 28719710 DOI: 10.1177/014556131709600720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Postoperative chylous fistula after neck dissection is an uncommon complication associated with significant patient morbidity. Octreotide acetate is a somatostatin analogue established in the treatment of chylothorax; however, its utility in the management of cervical chylous fistulae has not been fully evaluated. The investigators hypothesized that chylous fistula can be managed by a combination of octreotide and peripheral total parenteral nutrition (TPN). A retrospective review of cases compiled at our institution from 2009 to 2015 was conducted. Ten patients, all men, were identified as having a postoperative chylous fistula after a neck dissection. All patients were treated with peripheral TPN and intravenous octreotide. Mean age of the patients was 63.0 years (range 49 to 82). Five (50.0%) had a neck dissection for the management of metastatic nasopharyngeal carcinoma and had previous neck irradiation. In 8 (80%) patients, chylous fistula occurred in the left neck. Seven (70.0%) of the leaks occurred within the first 2 postoperative days. Eight (80%) leaks were controlled using TPN and octreotide, with 2 (20%) patients requiring surgical intervention. No factors were significant in the successful conservative management of chylous fistulae. One patient with a chylous fistula of 1,800 ml/day was managed successfully without surgical intervention. The results of this case series suggest that chylous fistulae may be managed conservatively with octreotide and TPN. However, long-term evaluation is needed to define if and when surgical intervention is required for control.
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Affiliation(s)
- Jason Y Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, N.T., Hong Kong SAR.
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16
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Abstract
Background Chyle fistula (CF) is a rare but challenging condition for the surgeon and the patient's health. Methods A retrospective review of single surgeon's case load in a 12-year period is presented, reviewing the case of those patients presenting with a CF. Results Three patients were found during this study period from more than 1,050 surgeries performed due to thyroid cancer. Patients underwent extensive lymph node dissection for advanced, metastatic and infiltrative disease. In all patients, a long hospital stay and surgical re-interventions were required. Conclusions A description of the management of CF is presented along with a review of current Literature.
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Affiliation(s)
- Carlos S Duque
- Head and Neck Surgeon, Hospital Pablo Tobón Uribe, Clínica Las Américas, Medellín, Colombia
| | - Juan Guillermo Sánchez
- Department of Otolaryngology, Universidad de Antioquia School of Medicine, Medellín, Colombia
| | - Gianlorenzo Dionigi
- Division of Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital-Policlinico "G. Martino", University of Messina, Messina, Italy
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17
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Lv S, Wang Q, Zhao W, Han L, Wang Q, Batchu N, Ulain Q, Zou J, Sun C, Du J, Song Q, Li Q. A review of the postoperative lymphatic leakage. Oncotarget 2017; 8:69062-69075. [PMID: 28978181 PMCID: PMC5620321 DOI: 10.18632/oncotarget.17297] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022] Open
Abstract
Lymphatic complications are rare, but well-known phenomena, and have been described by many researchers. However, many diagnoses of lymphatic complications are found confusing due to different definition. A literature search in Pubmed was performed for studies postoperative lympatic complications. These complications divided into two parts: lymphatic leakage and lymphatic stasis. This review is about lymphatic leakage, especially, postoperative lymphatic leakage due to the injury of lymphatic channels in surgical procedures. According to polytrophic consequences, many types of postoperative lymphatic leakage have been presented, including lymph ascites, lymphocele, lymphorrhea, lymphatic fistula, chylous ascites, chylothorax, chyloretroperitoneum and chylorrhea. In this review, we focus on the definition, incidence and treatment about most of these forms of lymphatic complications to depict a comprehensive view of postoperative lymphatic leakage. We hold the idea that the method of treatment should be individual and personal according to manifestation and tolerance of patient. Meanwhile, conservative treatment is suitable and should be considered first.
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Affiliation(s)
- Shulan Lv
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qing Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wanqiu Zhao
- Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Lu Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qi Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nasra Batchu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qurat Ulain
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Junkai Zou
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chao Sun
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiang Du
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qing Song
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, USA.,Center of Big Data and Bioinformatics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiling Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center of Big Data and Bioinformatics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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18
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Polistena A, Vannucci J, Monacelli M, Lucchini R, Sanguinetti A, Avenia S, Santoprete S, Triola R, Cirocchi R, Puma F, Avenia N. Thoracic duct lesions in thyroid surgery: An update on diagnosis, treatment and prevention based on a cohort study. Int J Surg 2015; 28 Suppl 1:S33-7. [PMID: 26708844 DOI: 10.1016/j.ijsu.2015.05.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/06/2015] [Accepted: 05/20/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Thoracic duct fistula at the cervical level is a severe but rare complication following thyroid surgery, particularly associated to lateral dissection of the neck and to mediastinal goiter. METHODS we retrospectively analyzed chylous fistulas observed in a cohort of 13.224 patients underwent surgery for thyroid disease since 1986 to 2014, in the Unit of Endocrine Surgery, S. Maria University Hospital, Terni, Italy. RESULTS We observed 20 cases of chylous fistula. Thirteen patients underwent primary surgery in our institution while the remaining 7 cases had been referred to our Department from other hospitals for an already diagnosed lymphatic leak. Surgical procedures carried out included total thyroidectomy for mediastinal goiter in 4 patients, total thyroidectomy for cancer in 2 patients, unilateral functional lymphadenectomy in 11 patients and bilateral in 3. Intraoperative repair was carried out in 4 cases. Of the remaining 16 cases, 4 of the 6 fistulas with low flow leakage healed in about 30 days of conservative treatment, 2 cases instead required surgical repair. All 10 patients with "high-flow" fistula underwent surgery. Despite surgery was performed later, postoperative course in patients with late surgical repair is similar to what observed in those patients with early surgical repair. Both groups underwent cervical drainage removal in post-operative day 4. CONCLUSION Healing of a cervical chylous fistula can be achieved by conservative medical therapy (nutritional and pharmacological) but in case of therapeutic failure with rapid decrease of general condition, the surgical approach is necessary. In our experience, duct ligation after unsuccessful conservative treatment, is the only resolutive treatment.
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Affiliation(s)
- Andrea Polistena
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
| | - Jacopo Vannucci
- Thoracic Surgery Unit, Medical School University of Perugia, Italy.
| | | | - Roberta Lucchini
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
| | | | - Stefano Avenia
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
| | | | - Roberta Triola
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
| | - Roberto Cirocchi
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
| | - Francesco Puma
- Thoracic Surgery Unit, Medical School University of Perugia, Italy.
| | - Nicola Avenia
- Endocrine Surgery Unit, Medical School University of Perugia, Italy.
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19
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Chen CY, Chen YH, Shiau EL, Liang HL, Chang HS, Chen HC. Therapeutic role of ultrasound-guided intranodal lymphangiography in refractory cervical chylous leakage after neck dissection: Report of a case and review of the literature. Head Neck 2015; 38:E54-60. [DOI: 10.1002/hed.24134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 12/14/2022] Open
Affiliation(s)
- Chia-Yu Chen
- Department of Oromaxillofacial Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Department of Stomatology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Yu-Hung Chen
- Department of Oromaxillofacial Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Department of Stomatology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - En-Li Shiau
- Department of Radiology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Hui-Lung Liang
- Department of Radiology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Hao-Sheng Chang
- Department of Stomatology; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Dental Laboratory Technology; Shu Zen College of Medicine and Management; Kaohsiung Taiwan
| | - Hung-Chih Chen
- Department of Oromaxillofacial Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- Dental Laboratory Technology; Shu Zen College of Medicine and Management; Kaohsiung Taiwan
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20
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Bi H, Fang S, Jiang D, Xing X, Zhu J, Wang X, Dai H, Zhong X, Li J. Ultrasound-guided scraping of fibrous capsule plus bilayered negative pressure wound therapy for treatment of refractory postmastectomy seroma. J Plast Reconstr Aesthet Surg 2014; 68:403-9. [PMID: 25547936 DOI: 10.1016/j.bjps.2014.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/29/2014] [Accepted: 11/09/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Seroma is a frequent complication of breast cancer surgery. Treatment of prolonged or refractory seroma remains a clinical challenge. This study aimed to evaluate the efficacy of a novel approach for refractory seroma treatment; the method combines minimally invasive scraping for fibrous capsule removal and self-designed bilayered negative pressure wound therapy (b-NPWT) to achieve favorable wound healing. METHODS Twenty-four patients with refractory seroma received ultrasound-guided scraping of fibrous capsule around the refractory seroma, and then a bilayered NPWT system simultaneously allowing for fluid drainage and dynamic topical pressure was manually implemented immediately. The time of NPWT application and wound healing was recorded, and pathological examination was conducted for the removed fibrous tissues. RESULTS Removal of the fibrous capsule was securely achieved by minimally invasive scraping through a 1.5-cm incision guided with ultrasound scanning. All refractory seromas in the 24 patients healed uneventfully after an average application of NPWT for 7.2±3.3 days without recurrence during the 3-12 months of follow-up. Biopsy of the removed fibrous tissue demonstrated that single-layered endothelial cells stained with CD31, D2-40, and Ki-67 existed both on the surface of and inside the fibrous tissue. CONCLUSIONS The combination of fibrous capsule removal by ultrasound-guided scraping with successive bilayered NPWT therapy is effective and minimally invasive for promoting wound healing of refractory postmastectomy seroma.
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Affiliation(s)
- Hongda Bi
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Shuo Fang
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Dong Jiang
- Department of Ultrasound, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xin Xing
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
| | - Ji Zhu
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xiaoyun Wang
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Haiying Dai
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Xueying Zhong
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Junhui Li
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
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21
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Usefulness of thoracic duct clipping in thoracoscopic surgery for chylous fistula occurring after neck dissection. Int Cancer Conf J 2013. [DOI: 10.1007/s13691-013-0137-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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22
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Abstract
PURPOSE OF REVIEW The present review is focused on the management of lymphatic, chylous, and thoracic duct lesions following head and neck surgery, with particular attention to these complications after neck dissection. Postoperative scenarios may include chylous fistula, chylothorax, chylomediastinum, chylopericardium, lymphocele, persistent lymphorrhea, and secondary lymphedema. RECENT FINDINGS There is a paucity of literature on the treatment of lymphatic, chylous, and thoracic duct injuries following head and neck surgery; however, this review suggests that the most appropriate treatment should include both conservative and surgical approaches. Nonsurgical options consist of low-fat diet with medium-chain triglycerides, total parenteral nutrition, careful monitoring of fluid and electrolytes, drainage of the leakage, somatostatin analogs such as octreotide, and negative-pressure wound therapy. On the other hand, surgical management includes therapeutic percutaneous lymphography-guided thoracic duct cannulation and embolization, thoracic duct ligation, excision and imbrication of leaking lymphatics, chylous fistula surgical/microsurgical repair, fistula closure by locoregional flaps, video-assisted thoracoscopic surgery, thoracotomy, pleurodesis and decortication, pericardial 'window', and pleura-venous/pleura-peritoneal shunts. In addition, single or, preferably, multiple lymphovenous anastomoses may be taken into account. SUMMARY The various possible clinical presentations of such challenging lymphatic, chylous, and thoracic duct injuries require an appropriate multidisciplinary approach by experienced teams. Primary prevention of these complications can be achieved through adequate surgical planning to minimize lesions, including structured and thorough patient assessment, and centralization of resources and teams.
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23
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Drain removal and aspiration to treat low output chylous fistula. Eur Arch Otorhinolaryngol 2013; 271:561-5. [DOI: 10.1007/s00405-013-2534-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/25/2013] [Indexed: 12/14/2022]
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Current World Literature. Curr Opin Oncol 2013; 25:325-30. [DOI: 10.1097/cco.0b013e328360f591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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