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Nutritional management of chyle leak after head and neck surgery: a systematic review and proposed protocol for management

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Abstract

Purpose

Chyle leaks are a rare complication of neck surgery causing local damage, impairing healing and compromising free flaps. High output leaks can result in electrolyte imbalances and malnutrition. Nutritional management such as restricting the absorption of triglycerides is believed to reduce chyle, allowing spontaneous resolution of a leak. Dietary preparations and management can aid in reducing chyle production. There are no clear guidelines to aid nutritional decision-making in this complex scenario.

Methods

A systematic review of the literature was carried out to identify studies evaluating nutritional management of chyle leaks in patients after neck dissections.

Results

Ten studies were identified evaluating the role of nutritional therapy in the management of patients with chyle leaks after neck dissections. The level of evidence was low. Several studies identified that low volume leaks (defined as < 1000 mls per day) often resolved by dietary management and other conservative measures. High volume leaks rarely resolved with conservative measures alone. Parenteral nutrition had an established role in this context.

Conclusions

There is limited evidence to guide dietary restriction and introduction of oral diet in patients with chyle leak after major head and neck surgery. Based on available evidence, local guidelines for the nutritional management of patients identified with a chyle leak were produced and adopted by the Trust and the head and neck MDT. A national database for voluntary contribution of prospective data would help to generate better quality management protocols.

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Data availability

The papers used in the systematic review that support the development of the protocol are available in the reference section with the identifiers (DOIs).

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Authors and Affiliations

  1. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Rebekah Smith, Prav Praveen & Sat Parmar

  2. Faculty of Medicine, Imperial College London, and the International Centre for Recurrent Head & Neck Cancer, Royal Marsden Hospital, London, UK

    James Higginson

  3. Royal Brisbane and Womens Hospital, Brisbane, Australia

    Omar Breik

Authors
  1. Rebekah Smith
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  2. James Higginson
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  3. Omar Breik
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  4. Prav Praveen
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  5. Sat Parmar
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Contributions

R.S and J.H conceived, designed and performed the literature review and reviewed all the papers for the systematic review. R.S, J.H and O.B preformed the analysis. The first draft of the manuscript was written by Rebekah Smith, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Rebekah Smith.

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Smith, R., Higginson, J., Breik, O. et al. Nutritional management of chyle leak after head and neck surgery: a systematic review and proposed protocol for management. Oral Maxillofac Surg 28, 51–62 (2024). https://doi.org/10.1007/s10006-023-01152-8

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  • DOI: https://doi.org/10.1007/s10006-023-01152-8

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