Effectiveness of therapeutic lymphography on lymphatic leakage

Alejandre-Lafont, Enrique; Krompiec, Christoph; Rau, W. S.; Krombach, Gabriele A.

doi:10.1258/ar.2010.090356

Cited by 121 publications

(66 citation statements)

References 18 publications

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“…Nevertheless, LAG has a high potential as a reliable method to visualize and directly occlude lymphatic leaks. In nearly 79% of patients, the location of the leak could be detected, and surgical intervention could be planned when therapeutic LAG failed [17]. Due to the irrigating effect of Lipiodol, the lymphatic leak could be completely occluded in 70% of patients when the lymphatic drainage volume was less than 500 mL/day.…”

Section: Discussionmentioning

confidence: 99%

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Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax

Liu

Shao

Shi

2014

J Cardiothorac Surg

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PurposeTo identify the value of unilateral pedal lymphangiography (LAG) with non-contrast CT in the location and treatment decision of idiopathic chylothorax after failure of thoracic duct ligation.Materials and MethodsTwenty four patients aged 9–84 year old (median 44 yr) who had idiopathic chylothorax were involved, and unilateral pedal LAG with non-contrast CT was performed in every patient. All patients failed to previous right supra-diaphragmatic thoracic duct ligation.ResultsThe amount of iodized oil used was 6–14 ml with no related complications. LAG demonstrated 8 patients with thoracic duct leaks and 10 patients with leaks elsewhere, but no visible chylous leak in 6 patients. Ligation of thoracic duct was performed as the primary treatment in all 8 cases as having thoracic duct leakage and cured 7(87.5%) patients. For 8 patients not having thoracic duct lesion under LAG, the successful rate of thoracic duct ligation was 25% (2 out of 8 patients), which was significantly lower than patients due to thoracic duct lesions (P = 0.02). Meanwhile, non-operative therapy had significantly higher successful rate (87.5% vs 25%, P = 0.02).ConclusionsUnilateral pedal LAG with non-contrast CT could identify the causes and locate the leaks of idiopathic chylothorax in 75% of patients after failure of thoracic duct ligation. Two thirds of patients were found not to have thoracic duct leakage and would be better managed by non-operative treatment.

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Section: Discussionmentioning

confidence: 99%

“…Even when lymphatic drainage was higher than 500 mL/day, therapeutic LAG was still successful in 35% of the patients. The overall success rate in patients with failed conservative treatment was 51% [17]. The speculated mechanism of attenuation of chyle leakage was thought to be as follows.…”

Section: Discussionmentioning

confidence: 99%

Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax

Liu

Shao

Shi

2014

J Cardiothorac Surg

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“…If the origin of the leak is definitely detected then surgical repair is preferred [12, 13]. However, imaging modalities for lymphatic structure in the abdomen require special instruments, materials, and expertise and are often unreliable [1–7, 12, 13].…”

Section: Discussionmentioning

confidence: 99%

Chylous ascites occurring after low anterior resection of the rectum successfully treated with an oral fat-free elemental diet (Elental®)

Nakayama

Morioka

Murakami

et al. 2012

Clin J Gastroenterol

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Chylous ascites occurring after abdominal surgery is rare. Despite being potentially critical, there is no definite treatment guideline because of its rarity. Here we present a case of massive chylous ascites occurring after rectal surgery which was successfully treated with an oral fat-free elemental diet (ED). A 67-year-old man underwent low anterior resection with para-aortic lymphadenectomy for advanced rectal cancer. Early postoperative course was uneventful and the patient was discharged from hospital 10 days after surgery; however, after discharge, abdominal distension rapidly developed. Abdominal computed tomography (CT) performed 3 weeks after surgery revealed massive ascites and laboratory findings showed remarkable hypoproteinemia and lymphopenia. Urgent diagnostic paracentesis showed the ascites to be a white milky fluid containing high levels of triglycerides (564 mg/dl), leading to a diagnosis of chyloperitoneum. Daily nutrition of the patient was entirely with a fat-free ED (30 kcal/kg/day of Elental®, Ajinomoto Pharmaceutical Co. Ltd, Tokyo, Japan). After the initiation of oral Elental®, abdominal distension, hypoproteinemia, and lymphopenia gradually improved. Abdominal CT performed 7 weeks after surgery showed no ascitic fluid in the abdomen, and thereafter a normal diet was initiated. Since then, no relapse of chyloperitoneum has been proven. As a result, the chylous ascites was successfully treated in the outpatient clinic.

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“…Számos non-vagy szemi-invazív radiológiai kezelés is alkalmazható traumás és nem traumás chylothorax esetén egyaránt (2. táblázat) [4,8,34,36,[53][54][55][56][57][58][59][60][61], bár zö-mük néhány központra korlátozódik [62].…”

Section: Intervenciós Kezelésunclassified

“…Diagnosztikus lymphographia után a chylothorax "spontán" gyógyulását az esetek felében fi gyelték meg [57,60]. Ugyanakkor a lymphographia kezelési sikere nehezen értékelhető, mert az esetek egyötödében nem is lehet kivitelezni, valamint 500 ml napi nyirokvesztés felett az esetek kétharmadában hatástalan.…”

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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Effectiveness of therapeutic lymphography on lymphatic leakage

Abstract: Therapeutic lymphography is an effective method in the treatment of lymphatic leakage when conservative therapy fails. The volume of lymphatic drainage per day is a significant predictor of the therapeutical success rate.

Cited by 121 publications

References 18 publications

Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax

Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax

Chylous ascites occurring after low anterior resection of the rectum successfully treated with an oral fat-free elemental diet (Elental®)

A chylothorax modern kezelésének bizonyítékalapú áttekintése

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