Abdominal compression: A new intraoperative maneuver to detect chyle fistulas during left neck dissections that include level IV

Abstract

To our knowledge, this is the first description of a specific maneuver to actively detect a lymphatic fistula at the end of a left neck dissection involving level IV. In this study, intraoperative abdominal compression was able to detect an open lymphatic vessel in 6.3% of the cases, as well as to assure its effective sealing in the remaining 93.7% of the patients. Moreover, no life-threatening high-volume fistula was noted in this study.

Predictors of Level II and Vb Neck Disease in Metastatic Papillary Thyroid Cancer

“…19,20 Furthermore, the risk of chyle leak is not insignificant in a comprehensive level IV and V neck dissection. 21 A highly selective neck dissection (limited to levels III and IV) would be advocated in patients with PTC and lateral neck disease if (1) the rate of metastasis to levels II and Vb was shown to be low, (2) it was possible to predict, on the basis of certain variables, which patients are at higher risk of involvement at these levels, and (3) the increased risk associated with these variables was clinically significant. In our cohort, levels II and Vb were involved with disease in a significant number of cases: 49.3% in level II and 29.2% in level Vb.…”

Management of Chyle Leak after Head and Neck Surgery: Review of Current Treatment Strategies

“…Maneuvers that increase intrathoracic or intra-abdominal pressure may facilitate the identification of a CL as well. Trendelenburg positioning and Valsalva maneuver while the anesthesiologist applies positive pressure to raise intrathoracic pressure [ 16 ] or manual abdominal compression [ 44 ] can propagate hydrostatic forces through the course of the thoracic duct to increase chyle flow and distend the distal thoracic duct to improve visibility. The presence of multiple terminations of the thoracic duct means that even though the thoracic duct may be identified and ligated at the time of surgery, unidentified terminal branches can still result in a CL.…”

Therapeutic role of ultrasound-guided intranodal lymphangiography in refractory cervical chylous leakage after neck dissection: Report of a case and review of the literature

“…Brennan et al recommend that patients should be placed in a Trendelenburg's position so the surgeons can observe the wound while increasing intrathoracic pressure via a Valsalva maneuver. Cernea et al presented a novel technique that required the endotracheal tube be temporarily disconnected from the ventilator while applying abdominal compression to detect lymphatic leakage in the dissected level IV area under clear visualization.…”