Skip to main content

Advertisement

SpringerLink
Log in

Finger-pressing: a simple and efficient way to stop chyle leak post neck dissection

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CL:

chyle leak

TPN:

total parenteral nutrition

References

  1. V. Merki, J. Pichler, R. Giger, G. Mantokoudis, Chylothorax in thyroid surgery: a very rare case and systematic review of the literature. J. Otolaryngol. Head Neck Surg. 45(1), 52 (2016)

    Article  Google Scholar 

  2. J.A. Glenn, T.W. Yen, G.G. Fareau, A.A. Carr, D.B. Evans, T.S. Wang, Institutional experience with lateral neck dissections for thyroid cancer. Surgery 158(4), 972–978 (2015)

    Article  Google Scholar 

  3. R.L. Crumley, J.D. Smith, Postoperative chylous fistula prevention and management. Laryngoscope 86(6), 804–813 (1976)

    Article  CAS  Google Scholar 

  4. R.T. Gregor, Management of chyle fistulization in association with neck dissection. Otolaryngol. Head Neck Surg. 122(3), 434–439 (2000)

    Article  CAS  Google Scholar 

  5. J.Y. Chan, E.W. Wong, S.K. Ng, C.A. van Hasselt, A.C. Vlantis, Conservative management of postoperative chylous fistula with octreotide and peripheral total parenteral nutrition. Ear Nose Throat J. 96(7), 264–267 (2017)

    Article  Google Scholar 

  6. I. Park, N. Her, J.H. Choe, J.S. Kim, J.H. Kim, Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer. Head Neck 40(1), 7–15 (2018)

    Article  Google Scholar 

  7. S.W. Delaney, H. Shi, A. Shokrani, U.K. Sinha, Management of chyle leak after head and neck surgery: review of current treatment strategies. Int. J. Otolaryngol. 2017, 8362874 (2017)

    Article  Google Scholar 

  8. A. Ilczyszyn, H. Ridha, A.J. Durrani, Management of chyle leak post neck dissection: a case report and literature review. J. Plast. Reconstr. Aesthet. Surg. 64(9), e223–e230 (2011)

    Article  Google Scholar 

  9. C.C. Campisi, F. Boccardo, C. Piazza, C. Campisi, Evolution of chylous fistula management after neck dissection. Curr. Opin. Otolaryngol. Head Neck Surg. 21(2), 150–156 (2013)

    Article  Google Scholar 

  10. B. Nussenbaum, J.H. Liu, R.J. Sinard, Systematic management of chyle fistula: the southwestern experience and review of the literature. Otolaryngol. Head Neck Surg. 122(1), 31–38 (2000)

    Article  CAS  Google Scholar 

  11. J.I. Ulibarri, Y. Sanz, C. Fuentes, A. Mancha, M. Aramendia, S. Sanchez, Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin. Lancet 336(8709), 258 (1990)

    Article  CAS  Google Scholar 

  12. A. Coskun, M. Yildirim, Somatostatin in medical management of chyle fistula after neck dissection for papillary thyroid carcinoma. Am. J. Otolaryngol. 31(5), 395–396 (2010)

    Article  Google Scholar 

  13. F.E. Lucente, T. Diktaban, W. Lawson, H.F. Biller, Chyle fistula management. Otolaryngol. Head Neck Surg. 89(4), 575–578 (1981)

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by Grants 2016C33141 and 2017 C33052 from the Science and Technology Department of Zhejiang Province.

Author information

Authors and Affiliations

  1. Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 1511 Jianghong Avenue, Hangzhou, 310000, China

    Dapeng Xiang, Binglong Bai, Jingying Zhang, Chengchen Wang, Mao Ye & Zhiyu Li

  2. Department of Vascular Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, Hangzhou, China

    Zhenjie Liu

  3. Department of General Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Tiantai People’s Hospital, Taizhou, China

    Tianyao Yang

Authors
  1. Dapeng Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhenjie Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tianyao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Binglong Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jingying Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chengchen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mao Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhiyu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhiyu Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xiang, D., Liu, Z., Yang, T. et al. Finger-pressing: a simple and efficient way to stop chyle leak post neck dissection. Endocrine 67, 374–378 (2020). https://doi.org/10.1007/s12020-019-02119-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-019-02119-0

Keywords

Search

Navigation