Advertisement

Lymphedema pp 455-462 | Cite as

Surgical Management

  • Richard G. Azizkhan
  • Jesse A. Taylor
Chapter

Abstract

This chapter focuses on surgical interventions for treating chyle reflux. As with many areas of vascular medicine, multidisciplinary management is the norm, with surgeons, medical specialists, and interventional radiologists all playing important roles. An understanding of chyle transportation from the bowel lacteals to the ­thoracic duct and venous system is important in planning treatment. When flow is disrupted, the anatomic location of a blockage or rupture in this ductal system may translate into chylous ascites, chylothorax, chylous cyst, chylopericardium, chyloptysis, chyluria, and skin lesions with chylorrhea. The goal of therapy is to restore balance to the lymphatic system through decreased lymph production, facilitation of physiological lymphatic pathways, or removal of regions of lymphatic dysplasia.

Keywords

Disseminate Intravascular Coagulation Thoracic Duct Chylous Ascites Vascular Medicine Manual Lymph Drainage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Campisi C, Eretta C, Pertile D, Da Rin E, Campisi C, et al. Microsurgery for treatment of peripheral lymphedema: long-term outcome and future perspective. Microsurgery. 2007;27(4):333-338.PubMedCrossRefGoogle Scholar
  2. 2.
    Wheeler AD, Tobias JD. Tension chylothorax in two pediatric patients. Paediatr Anaesth. 2007;17(5):488-491.PubMedCrossRefGoogle Scholar
  3. 3.
    Marts BC, Naunheim KS, Fiore AC, Pennington DG. Conservative versus surgical management of chylothorax. Am J Surg. 1992;164:532-534.PubMedCrossRefGoogle Scholar
  4. 4.
    Lim ST, Ngan H, Wong KK, Ong GB. Leakage of lymph through scrotal skin. J Urol. 1981;125(6):889-890.PubMedGoogle Scholar
  5. 5.
    Sales F, Trepo E, Brondello S, Lemaitre P, Bourgeois P. Eur J Surg Oncol. 2007;33(8):1042-1043.PubMedGoogle Scholar
  6. 6.
    Kinmonth JB, Taylor GW. Chylous reflux. Br Med J. 1964;I:529-532.CrossRefGoogle Scholar
  7. 7.
    Johnson WT. Cutaneous chylous reflux: the weeping scrotum. Arch Dermatol. 1979;115:164-166.Google Scholar
  8. 8.
    Alomari AI, Karian VE, Lord DJ, Padua HM, Burrows PE. Percutaneous sclerotherapy for lymphatic malformations: a retrospective analysis of patient-evaluated improvement. J Vasc Interv Radiol. 2006;17:1639-1648.PubMedCrossRefGoogle Scholar
  9. 9.
    Dasgupta R, Adams AD, Elluru R, Wentzel MS, Azizkhan RG. Noninterventional treatment of selected head and neck lymphatic malformations. J Pediatr Surg. 2008;43(5):869-873.PubMedCrossRefGoogle Scholar
  10. 10.
    Scorza LB, Goldstein BJ, Mahraj RP. Modern management of chylous leak following head and neck surgery: a discussion of percutaneous lymphangiography-guided cannulation and embolization of thoracic duct. Otolaryngol Clin North Am. 2008;41(6):1231-1240.PubMedCrossRefGoogle Scholar
  11. 11.
    Repko BM, Scorza LB, Mahraj RP. Recurrent chylothorax after neck surgery: percutaneous thoracic duct emobolization as primary treatment. Otolaryngol Head Neck Surg. 2009;141(3):426-427.PubMedCrossRefGoogle Scholar
  12. 12.
    Carati CJ, Anderson SN, Gannon BJ, Piller NB. Treatment of postmastectomy lymphedema with low-level laser therapy: a double blind, placebo-controlled trial. Cancer. 2003;98(6):1114-1122. Erratum in: Cancer. 2003 Dec 15; 98(12):2742.PubMedCrossRefGoogle Scholar
  13. 13.
    Kim NR, Lee SK, Suh YL. Primary intestinal lymphangiectasia treated by segmental resections of small bowel. J Pediatr Surg. 2009;44(10):e13-e17.CrossRefGoogle Scholar
  14. 14.
    Connolly M, Archer CB. Chylous reflux presenting with minimal milia-like lesions on the thigh. J Am Acad Dermatol. 2006;55(6):1108-1109.PubMedCrossRefGoogle Scholar
  15. 15.
    LeVeen HH, Wapnick S, Diaz C, Grosber S, Kinney M. Ascites: its correction by peritoneovenous shunting. Curr Probl Surg. 1979;16:1-61.PubMedCrossRefGoogle Scholar
  16. 16.
    Campisi C, Boccardo F, Zilli A, Maccio A, Gariglio A, et al. Peripheral lymphedema; new advances in microsurgical treatment and long-term outcome. Microsurgery. 2003;23:522-555.PubMedCrossRefGoogle Scholar
  17. 17.
    Koshima I, Inagawa K, Urushibara K, Moriguchi T. Super-microsurgical lymphaticovenular anastomosis for treatment of lymphedema in the upper extremities. J Reconstr Microsurg. 2000;16:437-442.PubMedCrossRefGoogle Scholar
  18. 18.
    Narushima M, Mihara M, Yamamoto Y, Lida T, Koshima I, et al. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg. 2010;125(3):935-943.PubMedCrossRefGoogle Scholar
  19. 19.
    Maldonado F, Cartin-Ceba R, Hawkins FJ, Ryu JH. Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci. 2010;339(4):314-318.PubMedGoogle Scholar
  20. 20.
    Paul S, Altorki NK, Port JL, Stiles BM, Lee PC. Surgical management of chylothorax. Thorac Cardiovasc Surg. 2009;57(4):226-228.PubMedCrossRefGoogle Scholar
  21. 21.
    Nguyen D. Successful management of postoperative chylothorax with fibrin glue in a premature neonate. Can J Surg. 1994;37(2):158-160. Review.PubMedGoogle Scholar
  22. 22.
    Barret DS. Pleurectomy for chylothorax associated with intestinal lymphangiectasia. Thorax. 1987;42:557-558.CrossRefGoogle Scholar
  23. 23.
    Robinson CL. The management of chylothorax. Ann Thorac Surg. 1985;39:90-95.PubMedCrossRefGoogle Scholar
  24. 24.
    Nath DS, Savla J, Khemani RG, Nussbaum DP, Greene CL, et al. Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg. 2009;88(1):246-251. discussion 251-252.PubMedCrossRefGoogle Scholar
  25. 25.
    Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative chylothorax. J Thorac Cardiovasc Surg. 1996;112:1361-1366.PubMedCrossRefGoogle Scholar
  26. 26.
    Azizkhan RG, Canfield J, Alford BA, Rodgers BM. Pleuroperitoneal shunts in the management of neonatal chylothorax. J Pediatr Surg. 1983;18(6):842-850.PubMedCrossRefGoogle Scholar
  27. 27.
    Podevin G, Levard G, Larroquet M, Gruner M. Pleuroperitoneal shunt in the management chylothorax caused by thoracic lymphatic dysplasia. J Pediatr Surg. 1999;34:1420-1422.PubMedCrossRefGoogle Scholar
  28. 28.
    Wolff AB, Silen ML, Kokoska ER, Rodgers BM. Treatment of refractory chylothorax with externalized pleuroperitoneal shunts in children. Ann Thorac Surg. 1999;68:1053-1057.PubMedCrossRefGoogle Scholar
  29. 29.
    Barili F, Polvani G, Topkara VK. Administration of octreotide for management of postoperative high-flow chylothorax. Ann Vasc Surg. 2007;21(1):90-92.PubMedCrossRefGoogle Scholar
  30. 30.
    Rasiah SV, Oei J, Lui K. Octreotide in the treatment of congential chylothorax. J Paediatr Child Health. 2004;40:585-588.PubMedCrossRefGoogle Scholar
  31. 31.
    Roehr CC, Jung A, Proquitte H, Blankenstein O, Hammer H, et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med. 2006;32:650-657.PubMedCrossRefGoogle Scholar
  32. 32.
    Kobayashi T, Kishimoto T, Kamata S, Otsuka M, Miyazaki M, et al. Rapamycin, a specific inhibitor of the mammalian target of rapamycin, suppresses lymphangiogenesis and lymphatic metastasis. Cancer Sci. 2007;98(5):726-733.PubMedCrossRefGoogle Scholar
  33. 33.
    Noel AA, Gloviczki P, Bender CE, Whitley D, Stanson AW, et al. Treatment of symptomatic primary chylous disorders. J Vasc Surg. 2001;34(5):785-791.PubMedCrossRefGoogle Scholar
  34. 34.
    Cope C, Kaiser LR. Management of unremitting chylothorax by percutaneous embolisation and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol. 2002;13:1139-1148.PubMedCrossRefGoogle Scholar
  35. 35.
    Leveen HH, Christoudias G, Ip M, Luft R, Falk G, Grosberg S. Peritoneo-venous shunting for ascites. Ann Surg. 1974;180(4):580-591.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Richard G. Azizkhan
    • 1
  • Jesse A. Taylor
  1. 1.Department of Surgery and PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations