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Prolonged iatrogenic thoracic duct chylous fistula in neck surgery: conservative management or surgery? A literature review
- Source :
- Scandinavian Journal of Surgery. 110:550-556
- Publication Year :
- 2021
- Publisher :
- SAGE Publications, 2021.
-
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.
- Subjects :
- medicine.medical_specialty
Fistula
Conservative management
business.industry
Bile duct ligation
Incidence (epidemiology)
Iatrogenic Disease
Chylous fistula
Conservative Treatment
Thoracic duct
Malignant disease
Thoracic Duct
Surgery
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
medicine.anatomical_structure
030220 oncology & carcinogenesis
medicine
Humans
030223 otorhinolaryngology
Complication
business
Subjects
Details
- ISSN :
- 17997267 and 14574969
- Volume :
- 110
- Database :
- OpenAIRE
- Journal :
- Scandinavian Journal of Surgery
- Accession number :
- edsair.doi.dedup.....430aec6ff36d073d5550e24ed3cab284