"How I do it"--head and neck. A targeted problem and its solution. Chylous fistula prevention and management

Prevention of chylous fistulae involves a careful search at the time of surgery for any possible chyle leaks. These should be ligated and the surgeon should be aware of the possible anatomical variations of both the thoracic duct and right lymphatic duct when he is searching for the leak. Treatment of the postoperative chyle fistula consists of elimination of long chain triglycerides from the diet and use of a medium chain triglyceride diet (Portagen), or oral feedings may be discontinued and intravenous fluids used exclusively. The supraclavicular area is treated with aspiration and pressure dressing. If the above measures are unsuccessful then surgical re-exploration is necessary.