Özet:

Objective: The purpose of this study was to determine the effectiveness of fibrin glue in the treatment of chylous fistula caused by neck dissection in the light of our experience and the literature. Material and Methods: We collected demographic data regarding age, gender, diagnosis, smoking habit and alcohol consumption, preoperative radiotherapy and previous surgery from nine patients with chylous fistula following neck dissection. We also retrospectively reviewed type of neck dissection, intraoperative chylous drainage, time of onset of postoperative drainage, time of withdrawal of chylous drainage, treatment protocols employed, need for re-exploration and length of hospital stay. Results: The study included nine patients (5 male, 4 female) with mean age of 54.7 years ranging from 34 to 70 years. It was found that postoperative fistula developed in six patients with intraoperative chylous fistula which were closed with ligation. Of these, re-exploration and fibrin glue were employed in two patients as conservative methods and octreotide failed to decrease drainage. In three patients, the fibrin glue was applied to defect site after ligation during primary surgery. Of these patients, postoperative low-output chylous fistula was detected in only one patient. The short-term (3 days) octreotide therapy was used in only one of three patients in whom fibrin glue was used during primary surgery. The mean duration of octreotide therapy was five days in patients in whom fibrin glue was used by re-exploration. Mean length of hospital stay ranged from 4 to 62 days. One patient died due to infection caused by chylous fistula, flap necrosis, fluid-electrolyte disorder and pulmonary embolism. Conclusion: We think that fibrin glue use during primary surgery may prevent development of postoperative fistula, particularly in selected patients such as those with metastatic lymph node or mass at level 4, those undergoing wide dissection or those with no clear identification of defective structures.

Anahtar Kelimeler: