Journal of Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2433-1783 Print ISSN: 2433-2720
Japanese Society of Pediatric Cardiology and Cardiac Surgery
Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of Pediatric Cardiology and Cardiac Surgery 3(2): 80-87 (2019)

Original ArticleOriginal Article

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

1Saitama Children’s Medical Center, Department of Plastic and Reconstructive Surgery ◇ Saitama, Japan

2Saitama Children’s Medical Center, Department of Cardiovascular Surgery ◇ Saitama, Japan

3Saitama Children’s Medical Center, Department of Cardiology ◇ Saitama, Japan

4Saitama Children’s Medical Center, Department of Surgery ◇ Saitama, Japan

5Saitama Children’s Medical Center, Department of Radiology ◇ Saitama, Japan

受付日:2018年11月7日Received: November 7, 2018
受理日:2019年2月21日Accepted: February 21, 2019
発行日:2019年7月1日Published: July 1, 2019

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.

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.

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.

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.

Key words: chylothorax; chyloabdomen; lymph surgery; flow-oriented; minimally invasive

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