Shih-Heng Chen1, Li-Fan Yeh1, Pedro Ciudad2,3, Hung-Chi Chen4,5. 1. Department of Plastic and Reconstructive Surgery, Chang-Gung Memorial Hospital, Chang-Gung Medical College, Chang-Gung University, Taoyuan, Taiwan. 2. Department of Plastic Surgery, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan. 3. Department of Medicine, China Medical University, Taichung, Taiwan. 4. Department of Plastic Surgery, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan. D19722@mail.cmuh.org.tw. 5. Department of Medicine, China Medical University, Taichung, Taiwan. D19722@mail.cmuh.org.tw.
Abstract
OBJECTIVE: For evaluation of a novel surgical procedure for the treatment of chylous ascites. Chylous ascites is a debilitating condition associated with high morbidity and mortality rates. At least one-third of patients are refractory to medical therapy and may warrant further treatment. Traditional methods involving ligation of lymphatic fistulas or small bowel resection do not address the basic pathophysiologic mechanism of the underlying obstruction, and identification of chyloperitoneal fistulas may be challenging. METHODS: A novel flap based on deep inferior epigastric vessels with its surrounding lymphatic fatty tissue was designed in this study and transferred into abdominal cavity, with anastomosis to the fourth jejunal vessels. Three consecutive cases with chylous ascites treated by this vascularized lymphatic cable transfer were retrospectively reviewed. RESULTS: All three patients recovered from chylous ascites after the lymphatic cable transfer and tolerated regular diet well, with follow-up of 3 years at least. CONCLUSIONS: Lymphatic cable flap based on the deep inferior epigastric vessels could be a potential option for treatment of intractable chylous ascites, with safe and successful long-term outcomes in three consecutive patients. The proposed functional mechanism of the flap is bypass of the obstructed intra-abdominal lymphatics to an extraperitoneal route as well as local lymphangiogenesis.
OBJECTIVE: For evaluation of a novel surgical procedure for the treatment of chylous ascites. Chylous ascites is a debilitating condition associated with high morbidity and mortality rates. At least one-third of patients are refractory to medical therapy and may warrant further treatment. Traditional methods involving ligation of lymphatic fistulas or small bowel resection do not address the basic pathophysiologic mechanism of the underlying obstruction, and identification of chyloperitoneal fistulas may be challenging. METHODS: A novel flap based on deep inferior epigastric vessels with its surrounding lymphatic fatty tissue was designed in this study and transferred into abdominal cavity, with anastomosis to the fourth jejunal vessels. Three consecutive cases with chylous ascites treated by this vascularized lymphatic cable transfer were retrospectively reviewed. RESULTS: All three patients recovered from chylous ascites after the lymphatic cable transfer and tolerated regular diet well, with follow-up of 3 years at least. CONCLUSIONS: Lymphatic cable flap based on the deep inferior epigastric vessels could be a potential option for treatment of intractable chylous ascites, with safe and successful long-term outcomes in three consecutive patients. The proposed functional mechanism of the flap is bypass of the obstructed intra-abdominal lymphatics to an extraperitoneal route as well as local lymphangiogenesis.