Advanced Search

Home > Journals > Minerva Chirurgica > Past Issues > Minerva Chirurgica 2006 February;61(1) > Minerva Chirurgica 2006 February;61(1):57-62

ISSUES AND ARTICLES   MOST READ   eTOC

CURRENT ISSUEMINERVA CHIRURGICA

A Journal on Surgery

Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,877

Frequency: Bi-Monthly

ISSN 0026-4733

Online ISSN 1827-1626

 

Minerva Chirurgica 2006 February;61(1):57-62

    CLINICAL CASES

Cervical lymphorrea after nodal dissection: role of fasting based on clinical evidence

Merante Boschin I., Meduri F., Toniato A., Pagetta C., Casalide E., Rubello D., Pelizzo M. R.

1 Dipartimento di Patologia Speciale Chirurgica Università di Padova, Padova
2 Servizio Di Medicina Nucleare, Unità PET Ospedale “S. Maria della Misericordia”, Rovigo

The management of chylous fistula, subsequent to neck nodal dissection, includes either unstandardized conservative procedures and reoperation. The main reason of controversy in literature is probably due to the rarity (1-2.5%) of such troublesome complication due to inadvertent disruption of the thoracic duct itself or of its tributary branches. We report one case of severe cervical chylous fistula, occurred after left lateral dissection for advanced papillary thyroid carcinoma, and successfully restored by a conservative approch. None of the following treatment modalities was effective: pressure dressing, low-fat diet, octreotide, etilefrine, and local tetracycline sclerotherapy. Instead, fasting combined with total venous nutritional replacement was successful in curing the leak. It may be hypothesized that the beneficial effect on chyle production observed in the present patient in fasting condition, could be explained by a decrease of splancnic blood flow consequent to intestinal feeding rest. The other treatment procedures can be adjunctive methods with impredictable effect. As a standard approach with the aim to prevent and treat cervical lymphorrea, we suggest preoperatory fat meal, intraoperative search for milky leak by positive respiratory pressure, ligation of the thoracic duct (a mesh coverage when necessary) if inadvertently damaged, but not a systematic search for it. Moreover, according to the amount and the duration of the leakage, fasting combined with venous supplement by central or peripheral access, in combination with local treatment by sclerosing agents appears to be efficacious. In our opinion, neck reoperation or intrathoracic ligation of the thoracic duct represent the last therapeutic option of unresponsive or untractable cases.

language: Italian


FULL TEXT  REPRINTS

top of page