eMedicine Specialties > General Surgery > Head and Neck

Perilymph Fistula: Follow-up

Author: Howard L Kaufman, MD, Chief, Division of Surgical Oncology, Columbia University
Coauthor(s): Joshua N Honeyman, Brown Medical School; Nicholas J Gargiulo III, MD, Staff Physician, Department of Surgery, Albert Einstein College of Medicine; Frank J Veith, MD, The William J von Liebig Chair in Vascular Surgery, Vice Chairman, Department of Surgery, Montefiore Medical Center; Clinical Visiting Professor, Department of Surgery, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Apr 29, 2008

Outcome and Prognosis

Both operative and nonoperative management of lymphatic injuries may worsen surgical outcome and prognosis after vascular reconstruction. The operative repair of lymphatic fistulae after infrainguinal reconstruction carries a better outcome and prognosis than the operative repair of lymphatic injuries that result in chylous ascites and chylothorax. Repair of the latter two complications requires reoperative exploratory laparotomy and/or thoracotomy.

In general, chylous ascites and chylothorax secondary to traumatic injury during vascular reconstruction carry a better prognosis than that occurring secondary to underlying neoplasia. A mortality rate of approximately 18% has been reported for chylous ascites developing after aortic surgery. Mortality rates ranging from 44-83% have been reported for chylous ascites developing secondary to an underlying neoplasm. A survey of several case reports revealed 1 patient of 6 who died after conservative treatment of chylothorax.

Future and Controversies

Few controversies exist in the management of lymphatic complications after vascular reconstruction. Use good clinical judgment to determine the patients who might benefit from more conservative medical management. Reserve operative intervention only for patients who can tolerate the physiologic stress of reoperation. Lymphatic complications after infrainguinal vascular reconstruction occur more frequently in diabetic patients and in those requiring reoperation.

The advent of endovascular reconstruction has limited tissue handling and dissection and has reduced the incidence of lymphatic complications. Further advancements in endovascular techniques will enable more complex procedures to be performed with a consequent reduction in operative morbidity and mortality rates.

 


More on Perilymph Fistula

Overview: Perilymph Fistula
Workup: Perilymph Fistula
Treatment: Perilymph Fistula
Follow-up: Perilymph Fistula
References
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References

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Further Reading

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Keywords

lymphatic fistula, lymphocele, thoracic duct fistula, chylous ascites, chylothorax, abdominal aortic reconstruction, laparotomy, total parenteral nutrition, TPN, lymphoscintigraphy, vascular reconstruction, lymphatic system

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Contributor Information and Disclosures

Author

Howard L Kaufman, MD, Chief, Division of Surgical Oncology, Columbia University
Howard L Kaufman, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American College of Surgeons, American Medical Association, Association for Academic Surgery, Illinois State Medical Society, Massachusetts Medical Society, New York Academy of Sciences, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

Coauthor(s)

Joshua N Honeyman, Brown Medical School
Disclosure: Nothing to disclose.

Nicholas J Gargiulo III, MD, Staff Physician, Department of Surgery, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

Frank J Veith, MD, The William J von Liebig Chair in Vascular Surgery, Vice Chairman, Department of Surgery, Montefiore Medical Center; Clinical Visiting Professor, Department of Surgery, Uniformed Services University of the Health Sciences
Disclosure: Vascular Innovation Ownership interest Other

Medical Editor

Alex Jacocks, MD, Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Amy L Friedman, MD, Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse
Amy L Friedman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Women's Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, Association of Women Surgeons, International College of Surgeons, International Liver Transplantation Society, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, and Transplantation Society
Disclosure: Nothing to disclose.

CME Editor

Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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