Possibility to Terminate Chylothorax/Abdomen by Minimum Invasive Pediatrics Lymph Surgery: A Surgical Strategy Based on the Etiology of the Lymph Flow

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  • Kato Motoi
    Saitama Children’s Medical Center, Department of Plastic and Reconstructive Surgery
  • Watanabe Shoji
    Saitama Children’s Medical Center, Department of Plastic and Reconstructive Surgery
  • Nomura Koji
    Saitama Children’s Medical Center, Department of Cardiovascular Surgery
  • Ko Yoshihiro
    Saitama Children’s Medical Center, Department of Cardiovascular Surgery
  • Kinami Hiroo
    Saitama Children’s Medical Center, Department of Cardiovascular Surgery
  • Ogawa Kiyoshi
    Saitama Children’s Medical Center, Department of Cardiology
  • Hoshino Kenji
    Saitama Children’s Medical Center, Department of Cardiology
  • Hishitani Takashi
    Saitama Children’s Medical Center, Department of Cardiology
  • Kawachi Sadataka
    Saitama Children’s Medical Center, Department of Cardiology
  • Kawashima Hiroshi
    Saitama Children’s Medical Center, Department of Surgery
  • Tanami Yutaka
    Saitama Children’s Medical Center, Department of Radiology

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<p>Background: Chylothorax/abdomen can lead to prolonged hospitalization, cause developmental delays, and sometimes become fatal. Therefore, the development of a new therapy for its treatment has been investigated. Owing to the rapidly expanding knowledge regarding central lymphatic disease, chylothorax/abdomen has been found to be recurrent and to leak due to lymphatic stenosis or obstruction. These lymphatic problems are similar to those in peripheral lymphatic disease, for which we analyzed the lymphatic flow and treated it with direct maneuver. Based on this, we have introduced minimally invasive procedures to correct the central lymphatic system.</p><p>Methods: We included 12 pediatric patients aged 30 days to 2 years. Five patients were diagnosed with hereditary diseases other than cardiac anomalies. All patients were followed for >6 months after the lymphatic procedures were performed. Medical treatment was preoperatively administered for 4 weeks and with diet/milk restrictions.</p><p>Results: Four patients were completely cured of lymphatic leakage, and 3 patients required further treatment. Five patients died during intensive care, mainly because of respiratory distress.</p><p>Conclusions: Lymphangiography and lymphatic venous anastomosis are the most commonly performed procedures, which are effective in some patients. This novel treatment remains limited to patients with complications. However, the new therapy that is based on lymphatic flow analysis may become a novel approach for refractory chylothorax/abdomen. Therefore, studies on lymphatic disease are ongoing, and further improvements are expected in the future.</p>

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