We were very interested in an excellent review by Santa-

olalla et al. (2009), on chylous stula after neck dissec-

tion. We agree with the intra-operative management as
outlined, although we do use tetracycline powder as an
adjunct and we concur with their conservative manage-
ment of two patients immediately post surgery for persis-
tent leaks.
However, the majority of leaks are not identied for 34
days post-operatively (Erisen et al. 2002) and they fail to
present the timing of stula development in the remain-
ing two patients in their cohort. It has been recommended
that as leakages discovered and reported during surgery
carry a high risk of chylous drainage post surgery, that the
immediate post-operative use of low-fat medium chain
triglycerides diet and other conservative measures should
be utilised from the outset after surgery even in those
patients deemed to have had a successful per-operative
repair (De Gier et al. 1996). In our experience in the
departments of Otolaryngology, Head and Neck Surgery at
the Mid-Western Regional Hospital, Limerick, and the
Aintree University Hospital, Liverpool, we have intro-
duced this prophylactic approach in addition to an intra-
operative repair in all patients noted to have chyle
extravasations during surgery and thus far have not had a
post-operative leak in those patients.
In their conclusion, Santaolalla et al. state that all chyle
leaks are on the left but this is somewhat ambiguous and
it should have read that all of the stulae reported in their
study were on the left as the right lymphatic duct can be
also be damaged during surgery.
PAUL LENNON
Department of Otolaryngology,
Head and Neck Surgery,
Mid-Western Regional Hospital,
Limerick,
Ireland
JOHN FENTON
Department of Otolaryngology,
Head and Neck Surgery,
Mid-Western Regional Hospital,
Limerick,
Ireland
REFERENCES
De Gier H.H., Balm A.J., Bruning P.F., Gregor R.T. & Hilgers F.J.
(1996) Systematic approach to the treatment of chylous leakage
after neck dissection. Head Neck 18, 347351.
Erisen L., Coskun H. & Basut O. (2002) Objective and early
diagnosis of chylous stula in the postoperative period. Oto-
laryngology Head and Neck Surgery 126, 172175.
Santaolalla F., Anta J.A., Zabala A., Del Rey Sanchez A., Martinez
A. & Sanchez J.M. (2009) Management of chylous stula as a
complication of neck dissection: a 10-year retrospective review.
European Journal of Cancer Care Dec 17. [Epub ahead of print].
Correspondence address: Paul Lennon, Dooradoyle Limerick Munster
Ireland L 1, Ireland (e-mail: paullennon81@gmail.com, paullennon81@
yahoo.ie).
DOI: 10.1111/j.1365-2354.2010.01208.x
European Journal of Cancer Care, 2010, 19, e11
Letter to the editor
Review of the management of chylous stula as a
complication of neck dissectionecc_1208 11
2010 Blackwell Publishing Ltd