The use of Monogen in the conservative management of chylous fistula.
BACKGROUND
Chylous fistula is an uncommon complication of lower neck dissection. If untreated, it can lead to severe electrolyte disturbance, fluid, and protein loss and ultimately threaten skin flaps and vital structures. Conservative management aims to decrease chyle volume by replacing long-chain triglycerides (LCTs) with medium-chain triglycerides in the diet or by total parenteral nutrition.


METHODS
In 2001, Greenlane Head and Neck unit conducted a prospective 2-year study of all patients with chylous fistula.


RESULTS
Eleven patients developed chylous fistula in the period between 2001 and 2003, out of 210 neck dissections. All cases were managed conservatively. The mean time to diagnosis was 1.5 days (1-4), time to closure was 8.1 days (4-26), and mean duration of treatment was 11.5 days (4-35).


CONCLUSIONS
We would recommend conservative management of chylous fistulae with a low LCT diet using Monogen alone to be continued only for the duration of the fistula.
Izzard
Mark E
ME
Department of Otolaryngology-Head and Neck Surgery, Auckland City Hospital, Auckland, New Zealand.
Crowder
Victoria L
VL
Southwell
Katherine E
KE
D000328:Adult; D000368:Aged; D002913:Chyle; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000178:diet therapy* / Q000209:etiology; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D008894:Milk Proteins / Q000008:administration & dosage*; D037981:Neck Dissection / Q000009:adverse effects; D011446:Prospective Studies; D013897:Thoracic Duct / Q000293:injuries*; D013997:Time Factors; D016896:Treatment Outcome
D008894:Milk Proteins; C482039:Monogen