The lymphatics in the pathophysiology of thoracic and abdominal surgical pathology: immunological consequences and the unexpected role of microsurgery.
The authors report their experience in the diagnosis and treatment of lymphatic and chylous disorders in the thoracic and abdominal areas. Sixteen patients (10 adults, 6 children) affected by primary chylous ascites with associated syndromes and consequent immunological incompetence were studied. Diagnostic investigations included abdominal sonography scans, lymphoscintigraphy, and lymphography combined with computed tomography and laparoscopy. Surgical treatment included laparoscopy, drainage of ascites and/or the chylothorax, treatment of abdominal and retroperitoneal chylous leaks, exeresis of lymphodysplastic tissues, ligation of incompetent lymph vessels also by CO(2) LASER, and chylo-venous and lympho-venous microsurgical shunts. Eleven patients did not have a relapse of the ascites and four patients had a persistence of a small quantity of ascites with no protein imbalance. All patients had an improvement of their immunocompetence. Median follow-up was 5 years. We demonstrated that the use of microsurgery is remarkably advantageous for performing a causal treatment of the dysfunction.
Boccardo
Francesco
F
Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San Martino Hospital, University of Genoa, Genoa, Italy. francesco.boccardo@unige.it
Bellini
Carlo
C
Eretta
Costantino
C
Pertile
Davide
D
Da Rin
Elisa
E
Benatti
Emanuela
E
Campisi
Mirko
M
Talamo
Giuseppina
G
Macciò
Alberto
A
Campisi
Corrado
C
Bonioli
Eugenio
E
Campisi
Corradino
C
D000328:Adult; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D002916:Chylothorax / Q000276:immunology / Q000601:surgery*; D002915:Chylous Ascites / Q000276:immunology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008026:Ligation / Q000379:methods; D008200:Lymphangiectasis / Q000276:immunology / Q000601:surgery*; D042601:Lymphatic Vessels / Q000473:pathology / Q000601:surgery*; D008220:Lymphography; D008279:Magnetic Resonance Imaging; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome