Multimodal Treatment of Chylous Fistula: A Retrospective Case-Control Study

Area of Science:

• Surgery
• Gastroenterology
• Vascular Surgery

Background:

• Chylous fistulas (CF) are uncommon postoperative complications with no established treatment guidelines.
• Lymphatic duct injury, often occurring during abdominal surgery like nephrectomy, leads to CF.

Purpose of the Study:

• To evaluate treatment modalities for chylous fistulas over a 10-year period.
• To identify factors influencing resolution time and hospital stay in CF patients.

Main Methods:

• Retrospective analysis of 29 patients with chylous fistulas.
• Assessment of conservative management (fasting, TPN, somatostatin) and interventional procedures (surgical ligation, embolization).

Main Results:

• Conservative treatment resolved 75.8% of CF cases.
• Thoracic fistulas and cases associated with malignancy showed significantly longer resolution times and hospital stays.
• No recurrence or major complications were observed during follow-up.

Conclusions:

• Fasting, TPN, and somatostatin analogs are effective first-line treatments for chylous fistulas.
• Surgical ligation and interventional radiology offer alternative options for refractory cases.
• Understanding factors like fistula location and underlying malignancy aids in managing CF outcomes.