Lymphaticovenous bypass of the thoracic duct for the treatment of chylous leak in central conducting lymphatic anomalies.
Adolescent
Adult
Anastomosis, Surgical
/ methods
Child
Child, Preschool
Chylothorax
/ etiology
Female
Humans
Infant
Lymphatic Abnormalities
/ complications
Lymphatic Vessels
Lymphography
/ methods
Male
Middle Aged
Protein-Losing Enteropathies
/ etiology
Thoracic Duct
/ abnormalities
Vascular Surgical Procedures
/ adverse effects
Young Adult
Central conducting lymphatic anomaly
Lymphaticovenous
Protein-losing enteropathy
Thoracic duct
Journal
Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
06
02
2018
revised:
15
07
2018
accepted:
16
08
2018
pubmed:
8
10
2018
medline:
26
3
2019
entrez:
8
10
2018
Statut:
ppublish
Résumé
Central conducting lymphatic anomalies (CCLA) may cause chylous leaks and protein-losing enteropathy (PLE) owing to dysfunction of the central lymphatic channels. Most of the treatment strategies for these conditions are palliative and provide transient improvement. We treated 14 patients with intractable chylous leak and/or PLE using a novel technique of lymphaticovenous bypass of the terminal portion of the thoracic duct. Chylous leaks occurred in multiple different anatomic sites. All patients had CCLA and failure of thoracic duct emptying demonstrated by preoperative intranodal lymphangiography. Five patients had complete resolution of symptoms, and two patients had partial improvement. There were no major complications. Of 5 patients with PLE, only one improved after lymphaticovenous bypass. Repeat traditional lymphangiography was performed in 4 patients who did not improve, demonstrating patency of the bypass in all cases with persistent sluggish drainage. One patient had repeat MR lymphangiography that did not show the thoracic duct well. Bypass of the terminal thoracic duct is a novel procedure that offers improvement and a chance of cure for some patients with devastating manifestations of CCLA who lack other effective therapeutic options. IV.
Sections du résumé
BACKGROUND
BACKGROUND
Central conducting lymphatic anomalies (CCLA) may cause chylous leaks and protein-losing enteropathy (PLE) owing to dysfunction of the central lymphatic channels. Most of the treatment strategies for these conditions are palliative and provide transient improvement.
METHODS
METHODS
We treated 14 patients with intractable chylous leak and/or PLE using a novel technique of lymphaticovenous bypass of the terminal portion of the thoracic duct. Chylous leaks occurred in multiple different anatomic sites. All patients had CCLA and failure of thoracic duct emptying demonstrated by preoperative intranodal lymphangiography.
RESULTS
RESULTS
Five patients had complete resolution of symptoms, and two patients had partial improvement. There were no major complications. Of 5 patients with PLE, only one improved after lymphaticovenous bypass. Repeat traditional lymphangiography was performed in 4 patients who did not improve, demonstrating patency of the bypass in all cases with persistent sluggish drainage. One patient had repeat MR lymphangiography that did not show the thoracic duct well.
CONCLUSIONS
CONCLUSIONS
Bypass of the terminal thoracic duct is a novel procedure that offers improvement and a chance of cure for some patients with devastating manifestations of CCLA who lack other effective therapeutic options.
LEVEL OF EVIDENCE
METHODS
IV.
Identifiants
pubmed: 30292452
pii: S0022-3468(18)30564-5
doi: 10.1016/j.jpedsurg.2018.08.056
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
562-568Informations de copyright
Copyright © 2018. Published by Elsevier Inc.