title: The management of chyle fistula.
abstract: Over a recent 4-year period, 823 neck dissections that included the lower jugular lymph nodes were performed. Of the 823, 14 (1.9%) patients developed chyle fistulas. Two other patients developed fistulas, one after undergoing a gastric transposition, and the other after a scalene node biopsy. All 16 patients were initially managed conservatively with closed-wound drainage and low-fat nutritional support; this was successful in only 4 patients, 3 of whom had peak 24-hour chyle drainage of less than 600 cc. The remaining 10 patients required open-wound management, which included operative ligation in 4 instances. Continued conservative treatment with an open neck wound resulted in significant additional hospitalization. Our experience indicates that closed-wound management of a chyle fistula is likely to fail when peak 24-hour fistula output exceeds 600 cc. Considering the cost and morbidity of conservative treatment, early reoperation may be appropriate in those patients with high fistula output.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y.
authors.forename: J D
authors.initials: JD
authors.lastname: Spiro
authors.forename: R H
authors.initials: RH
authors.lastname: Spiro
authors.forename: E W
authors.initials: EW
authors.lastname: Strong
mesh_terms: D002913:Chyle; D002916:Chylothorax / Q000209:etiology; D004322:Drainage / Q000379:methods; D005402:Fistula / Q000097:blood / Q000209:etiology* / Q000628:therapy; D006801:Humans; D009333:Neck / Q000601:surgery*; D037981:Neck Dissection / Q000009:adverse effects; D010996:Pleural Effusion / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation; D012709:Serum Albumin / Q000378:metabolism; D013897:Thoracic Duct / Q000293:injuries*
chemical_list: D012709:Serum Albumin