Dapeng Xiang1, Zhenjie Liu2, Tianyao Yang3, Binglong Bai1, Jingying Zhang1, Chengchen Wang1, Mao Ye1, Zhiyu Li4. 1. Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 1511 Jianghong Avenue, Hangzhou, 310000, China. 2. Department of Vascular Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, Hangzhou, China. 3. Department of General Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Tiantai People's Hospital, Taizhou, China. 4. Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 1511 Jianghong Avenue, Hangzhou, 310000, China. pkudaniel@hotmail.com.
Abstract
PURPOSE: Postoperative chyle leak (CL) is a rare but severe complication after neck dissection. Conservative first-line treatments, such as total parenteral nutrition (TPN), octreotide and pressure dressing, can significantly prolong the hospital stay. Efficient and well-tolerated conservative treatment options are still lacking. METHODS: We have developed a new maneuver to treat CL called "finger-pressing." A thumb is pressed against the point of leakage between the two muscle heads of the sternocleidomastoid. Finger-pressing continues for about 24 h until CL stops. We used this maneuver to treat six CL patients. Drainage output and duration of hospital stay were compared with another six CL patients treated using the traditional pressure dressing. RESULTS: The finger-pressing maneuver cured all six CL patients. Most CLs (5/6) could be controlled after about 24 h pressing. Only one high-output CL required 72 h of finger-pressing to stop the leak. All patients had their drainage tubes removed within 3 days after pressing started and all patients tolerated the treatment well. In the control group, the traditional pressure dressing time varied from 2 to 5 days, until the patient was no longer able to cooperate. Three patients underwent a second operation that cured the CL in two cases. The average hospital stay was significantly longer than that in the finger-pressing group (20 vs 9 days, p = 0.037). CONCLUSIONS: Finger-pressing is an efficient and well-tolerated method for treating CL post neck dissection. This maneuver could be a useful adjuvant therapy to traditional methods in treating CL.
PURPOSE: Postoperative chyle leak (CL) is a rare but severe complication after neck dissection. Conservative first-line treatments, such as total parenteral nutrition (TPN), octreotide and pressure dressing, can significantly prolong the hospital stay. Efficient and well-tolerated conservative treatment options are still lacking. METHODS: We have developed a new maneuver to treat CL called "finger-pressing." A thumb is pressed against the point of leakage between the two muscle heads of the sternocleidomastoid. Finger-pressing continues for about 24 h until CL stops. We used this maneuver to treat six CL patients. Drainage output and duration of hospital stay were compared with another six CL patients treated using the traditional pressure dressing. RESULTS: The finger-pressing maneuver cured all six CL patients. Most CLs (5/6) could be controlled after about 24 h pressing. Only one high-output CL required 72 h of finger-pressing to stop the leak. All patients had their drainage tubes removed within 3 days after pressing started and all patients tolerated the treatment well. In the control group, the traditional pressure dressing time varied from 2 to 5 days, until the patient was no longer able to cooperate. Three patients underwent a second operation that cured the CL in two cases. The average hospital stay was significantly longer than that in the finger-pressing group (20 vs 9 days, p = 0.037). CONCLUSIONS: Finger-pressing is an efficient and well-tolerated method for treating CL post neck dissection. This maneuver could be a useful adjuvant therapy to traditional methods in treating CL.
Authors: Jason A Glenn; Tina W F Yen; Gilbert G Fareau; Azadeh A Carr; Douglas B Evans; Tracy S Wang Journal: Surgery Date: 2015-07-15 Impact factor: 3.982