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

• Published in: Lymphology Vol. 56; no. 2; p. 82
• Main Authors: Dalci, K, Gumus, S, Saritas, A G, Onan, H B, Akeam, A T, Ulku, A, Sakman, G
• Format: Journal Article
• Language: English
• Published: United States 2023
• Subjects: Adult; Aged; Case-Control Studies; Chylous Ascites - etiology; Chylous Ascites - therapy; Combined Modality Therapy; Female; Fistula - etiology; Fistula - surgery; Humans; Male; Middle Aged; Retrospective Studies; Somatostatin - therapeutic use; chylous leakage; ductus ligation; somatostatin; chylous fistula

Chylous fistulas (CF) are rare surgical complications and there is no standard treatment. This study presents the treatment modalities performed on patients who developed CF over a 10-year period. During the observation period, CF developed in 29 patients, 16 of whom were women. The mean age was 55.76± 13.48. Lymphatic duct injury was mostly seen in the abdomen (58.6%) and the most common reason was nephrectomy (20.7%). Extended lymphatic dissection due to malignancy was performed in 82.7% of all cases. Chylous leakage started postoperatively on 3.78±3.94 days (range: 1-19 days). Fasting, total parenteral nutrition (TPN), and somatostatin treatment were applied to all patients, and 75.8% of the fistulas were resolved completely with medical treatment. Surgical ligation of the lymphatic canal was performed in 7 patients. One was not successful and underwent percutaneous embolization of the thoracic lymphatic leakage cavity. All fistulas were resolved in 18.18±10.4 days. The resolution time and hospital stay were significantly higher in thoracic fistulas (p=0.017; p=0.003, respectively). In addition, malignant cases had longer resolution time (32.40±28.72 vs 16.27±11.25, p=0.036) and hospital stay (35.0±29.74 vs 16.25±14.05p= 0.002 respectively) than non-malignant. There was no chylothorax, chylous ascites, or recurrence at 20.55±22.88 months follow-up. Treatment of CF with fasting, TPN, and somatostatin analogs are effective. Other interventions such as surgical ligation with or without fibrin glue and interventional radiology treatments may be considered when conservative treatments fail.