ISSN: 1300 - 6525 E-ISSN: 2149 - 0880
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ORIGINAL RESEARCH

Could Potential Postoperative Chylous Fistula Be Prevented in Patients Undergoing Neck Dissection by Using Fibrin Glue?
Boyun Diseksiyonu Yapılan Hastalarda Postoperatif Gelişebilecek Şilöz Fistüller FibrinYapıştırıcı ile Önlenebilir mi?
Received Date : 19 Aug 2020
Accepted Date : 11 Nov 2020
Available Online : 11 Feb 2020
Doi: 10.24179/kbbbbc.2020-78548 - Makale Dili: EN
KBB ve BBC Dergisi. 2021;29(1):39-43
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
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.
ÖZET
Amaç: Fibrin yapıştırıcının boyun diseksiyonuna bağlı şilöz fistül tedavisindeki etkinliğinin, klinik tecrübemiz ve literatür eşliğinde değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Boyun diseksiyonu sonrasında şilöz fistül gelişen 9 hastanın yaş, cinsiyet, tanı, sigara ve alkol kullanımı, preoperatif radyoterapi ve geçirilmiş cerrahi öykülerini içeren demografik veriler toplandı. Ayrıca boyun diseksiyonunun tipi, intraoperatif şilöz drenaj durumu, postoperatif drenajın başlangıç günü, şilöz drenajın kesildiği süre, uygulanan tedavi protokolleri, re-eksplorasyon ihtiyacı ve hastanede yatış süreleri retrospektif olarak değerlendirildi. Bulgular: Çalışmaya, yaşları 34- 70 arasında değişen ve ortalaması 54,7 olan 9 (5 erkek, 4 kadın) hasta dâhil edildi. İntraoperatif şilöz fistül görülen ve ligasyon ile kapatılan 6 hastada postoperatif şilöz fistül geliştiği görüldü. Bu hastaların 2’sinde konservatif tedavi ve oktreotid ile drenaj azalmadığı için reeksplorasyon yapıldı ve fibrin yapıştırıcısı uygulandı. Üç hastada, primer cerrahi sırasında ligasyondan sonra defekt bölgesine fibrin yapıştırıcısı uygulandı. Bu hastaların ise yalnızca birinde düşük debili şilöz fistül gelişti. Primer cerrahi sırasında fibrin yapıştırıcı kullanılan 3 hastadan sadece birinde kısa süreli (3 gün) oktreotid tedavisi kullanıldı. Fibrin yapıştırıcısının, re-eksplorasyon sırasında kullanıldığı hastalarda ortalama oktreotid tedavisi süresi ise 5 gündü. Ortalama hastanede kalış süresi 4-62 gün arasında idi. Bir hasta şilöz fistül, flep nekrozu, sıvı-elektrolit bozukluğu ve pulmoner emboli nedeniyle oluşan enfeksiyon nedeniyle öldü. Sonuç: Fibrin yapıştırıcının primer cerrahi esnasında; özellikle düzey 4’te metastatik lenf nodu veya kitlesi olan, geniş diseksiyon yapılan, hasarlı yapıların net tespit edilemediği olgular başta olmak üzere, seçilmiş olgularda kullanılması ile postoperatif fistül gelişiminin engellenebileceği kanaatindeyiz.
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