title: Mesenteric lymphatic ligation in the prevention of chylous fistulae in abdominal neuroblastoma surgery.
abstract: OBJECTIVE
  We evaluated the effectiveness of prophylactic mesenteric lymphatic ligation in preventing iatrogenic chylous fistulae in abdominal neuroblastoma surgery.
  
  
  METHODS
  All patients who underwent resection of abdominal neuroblastoma between years 2002 and 2013 were included. A change in surgical strategy commenced from August 2010 when routine meticulous mesenteric lymphatic ligation (MLL) before abdominal closure was included in the primary surgery, thereby forming two study groups (Group A: before routine MLL; Group B: after routine MLL). Patients' demographics, disease characteristics, operative techniques, postoperative management and outcome were reviewed.
  
  
  RESULTS
  There were 64 patients in Group A and 35 patients in Group B. Ten (15.6%) patients from Group A compared to none from Group B developed chylous fistulae (p = 0.01). No significant morbidity was associated with MLL. Patients' and disease characteristics in both groups were not statistically different. Patients who developed chylous fistulae were managed with combinations of dietary modifications or complete bowel rest, total parenteral nutrition and prolonged abdominal drainage. Two patients underwent laparotomy and ligation of the chylous fistulae.
  
  
  CONCLUSIONS
  Chylous fistulae complicating abdominal neuroblastoma surgery disrupt neuroblastoma treatment. Meticulous MLL can be preventative if performed routinely before abdominal closure in the primary surgery.
authors.affiliation: Surgery Centre for Children, Unit 10-08 Mount Elizabeth Medical Centre, 3 Mount Elizabeth, Singapore, 228510, Singapore, chchui@surgeryforchildren.com.
authors.forename: Chan-Hon
authors.initials: CH
authors.lastname: Chui
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002913:Chyle; D015331:Cohort Studies; D016154:Digestive System Fistula / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D008026:Ligation; D008297:Male; D009447:Neuroblastoma / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012186:Retroperitoneal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013897:Thoracic Duct / Q000601:surgery*
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