Conservative Treatment of Postsurgical Lymphatic Leaks With Somatostatin-14

Collard, Jean-Marie; Laterre, Pierre‐François; Boemer, F; Reynaert, Marc; Ponlot, Robert

doi:10.1378/chest.117.3.902

Cited by 119 publications

(75 citation statements)

References 15 publications

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“…They could also respond to somastostatin therapy. 9 Somastostatin was not used in our case as it can cause hypotension and our patient presented with hypotension and electrolyte imbalance. However, a somatostatin analogue, Octreotide is the agent most commonly employed, beginning with a dose of 50 mcg thrice a day (TID) given subcutaneously, upto a maximum of 200 mcg TID.…”

Section: Discussionmentioning

confidence: 88%

Anesthetic and critical care challenges in massive chyle leak following robotic surgery: a special case report

Hariharan¹,

Choudhary

Bhargava

2015

J. Soc. Anesth. Nep.

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A unique case report is hereby presented which entails the multi-modality management of a very rare complication of modern minimally-invasive robotic surgery. Chyle leak can be an extremely challenging problem following certain surgeries, especially in cancer patients. Medical, nutritional and/or surgical management is required to control the leak. Prolonged massive chyle leaks which do not respond to conservative management require surgical intervention. Retroperitoneal lymph node dissection is a complex procedure undertaken for lymph node clearance in germ cell tumors after primary radical surgery. Robotic surgeries have revolutionized the field of minimally invasive operations. A patient who underwent robotic nerve sparing retroperitoneal lymph node dissection for non-seminomatous germ cell tumor of the right testis, post-chemotherapy, developed a continuous large volume chylous ascites, presenting with electrolyte imbalances and hypotension. Exploratory laparotomy in the operation theatre was required for sealing the chyle leak after failure of medical and nutritional management in the intensive care unit. The main take-away message is that refractory chyle leak can occur in retroperitoneal surgeries requiring multidisciplinary management. Careful coordinated action between critical care, oncological, anesthesia and surgical teams is mandatory for a favourable outcome. Familiarity with the nuances of robotic surgery and eternal vigilance are the keys to successful conduction of complex robotic procedures.Journal of Society of Anesthesiologists of Nepal 2015; 2(2): 73-76

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Section: Discussionmentioning

confidence: 88%

Anesthetic and critical care challenges in massive chyle leak following robotic surgery: a special case report

Hariharan¹,

Choudhary

Bhargava

2015

J. Soc. Anesth. Nep.

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“…Initial experience with continuous intravenous high-dose somatostatin for closure of postoperative lymphorrhagia was reported in 1990 by Ulibarri et al[ 26], satisfactory results were also achieved by others [22,23,24,25]. The exact mechanism involved in the claimed favorable effect of somatostatin is not completely understood.…”

Section: Discussion (Table 1)mentioning

confidence: 99%

“…The exact mechanism involved in the claimed favorable effect of somatostatin is not completely understood. It has been previously shown to decrease the intestinal absorption of fats, to lower triglyceride concentration in the thoracic duct and to attenuate lymph flow in the major lymphatic channels [23]. In addition, it also decreases gastric, pancreatic and intestinal secretions, inhibits motor activity of the intestine, slows the process of intestinal absorption and decreases splanchnic blood flow, which further contributes to decrease lymph production [25].…”

Section: Discussion (Table 1)mentioning

confidence: 99%

Compartimentalization for Chylothorax Originating from the Abdomen after Extended Esophagectomy

Omloo¹,

Lagarde²,

Vrouenraets³

et al. 2006

Dig Surg

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Background: Chyle leakage from the chest after extended esophagectomy originating from the abdomen is a rare complication with various clinical presentations and treatments. Methods: Two cases of chylothorax originating from the abdomen are discussed and the literature concerning diagnosis, management and outcome is reviewed. Results and Conclusion: Initially conservative measures should be installed; however, prolonged conservative treatment should be avoided. Reoperation gives an opportunity to identify the leak. If the leakage originates from the abdomen, compartimentalization is the essential step to solve the problem.

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“…Ha a drénvezetés jelentősen csökken konzervatív kezelés hatására, javasolt a terápia állandósítása néhány hé-tig fenntartott szigorú MCT-vagy zöldség-gyümölcs diéta mellett [22,48,49].…”

Section: áBraunclassified

“…Ugyanakkor a pleurodesis csak teljesen kitágulni képes tüdővel rendelkező betegeknél lehet sikeres (úgynevezett non-trapped tüdő esetén) [32]. A pleurodesis sikerrátája 71-100% közötti (2. táblázat), de 15%-os komplikációs rátával kell szá-molni [34,49].…”

Section: Intervenciós Kezelésunclassified

A chylothorax modern kezelésének bizonyítékalapú áttekintése

2016

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A chylothorax napjainkban rendszerint műtéti vagy baleseti szövődmény, ritkábban daganat következménye. Prospektív vagy randomizált vizsgálatok hiányában a bizonyítékalapú kezelés személyes tapasztalaton, ideálisan a retrospektív elemzések ismeretében történik. A szerzők célja a chylothorax modern kezelésének áttekintése. A PubMed adatbázist "chylothorax" kulcsszóra szűrték az elmúlt tíz év közleményei között, kiemelve az összehasonlító értéke-léseket. A módszerek és ajánlások kritikai elemzésekor a szerzők együttes 39 éves klinikai tapasztalatukra támaszkod-tak. A konzervatív kezelés sikere az etiológiától függően nagy szórást mutat (3-90%). A non-és szemi-invazív intervenciós eljárások sikerrátája 50-100% közötti. Eredménytelen konzervatív kezeléskor a sebészi kezelés, elsősorban a ductus thoracicus lekötése jelenti a standard terápiát. Ezen beavatkozások sikerességi aránya 64-100% közötti, a morbiditási/mortalitási mutató elérheti a 25%-ot. A kezelést konzervatívan kell megkezdeni, majd egy lépcsőzetes agresszivitású terápia ajánlott, amelyben a beteg állapota és a drénvolumen irányítják a döntéshozatalt. Az intervenciós radiológiai eljárások biztonságosak, sikeresek és helyet kaptak a konzervatív és műtéti megoldások mellett. Orv. Hetil., 2016, 157(2), 43-51. Kulcsszavak: chylothorax, szövődmény, mellkassebészet Review of evidence-based modern treatment for chylothoraxChylothorax is a multi-factorial complication, frequently of an operation or an accident, but rarely of a tumour. In the absence of prospective or randomised studies evidence-based treatment is normally based on personal experience, ideally in the possession of retrospective analyses using the "best practice" method. The aim of the authors was the review the up-to-date chylothorax treatments. They performed the PubMed database's "chylothorax" keyword search of the publications reported in the last ten years. They put emphasis on articles that included a comparative analysis of the various treatment options. During the critical analysis of the methods and recommendations, the authors relied on their own joint experience amounting to 39 years. The results showed that the success of the initial conservative treatment indicates a signifi cant deviation depending on the etiology (3-90%). The success rate of noninvasive or semi-invasive interventions is between 50-100%, again depending on the etiology. The standard surgical treatment following an unsuccessful conservative treatment of an operable patient includes the fi tting of a (thoracoscopic) knot to the ductus thoracicus, pleurodesis, insertion of a permanent chest drain or a pleuroperitoneal shunt. The success rate of these interventions is between 64-100%, with a morbidity index and mortality index exceeding 25%. Conservative treatment should be the fi rst step, which should then be followed by a gradually increased aggressive therapy, during which the decisions should be made according to the patient's condition and the drain volume. Interventional radiology procedures are safe, successful an...

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Conservative Treatment of Postsurgical Lymphatic Leaks With Somatostatin-14

Cited by 119 publications

References 15 publications

Anesthetic and critical care challenges in massive chyle leak following robotic surgery: a special case report

Anesthetic and critical care challenges in massive chyle leak following robotic surgery: a special case report

Compartimentalization for Chylothorax Originating from the Abdomen after Extended Esophagectomy

A chylothorax modern kezelésének bizonyítékalapú áttekintése

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