title: The lymphatics in the pathophysiology of thoracic and abdominal surgical pathology: immunological consequences and the unexpected role of microsurgery.
abstract: 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.
authors.affiliation: Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San Martino Hospital, University of Genoa, Genoa, Italy. francesco.boccardo@unige.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Boccardo
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellini
authors.forename: Costantino
authors.initials: C
authors.lastname: Eretta
authors.forename: Davide
authors.initials: D
authors.lastname: Pertile
authors.forename: Elisa
authors.initials: E
authors.lastname: Da Rin
authors.forename: Emanuela
authors.initials: E
authors.lastname: Benatti
authors.forename: Mirko
authors.initials: M
authors.lastname: Campisi
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Talamo
authors.forename: Alberto
authors.initials: A
authors.lastname: Macciò
authors.forename: Corrado
authors.initials: C
authors.lastname: Campisi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Bonioli
authors.forename: Corradino
authors.initials: C
authors.lastname: Campisi
mesh_terms: 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