Chylous complications of various severity and manifestations within diverse compartments in reconstructive vascular surgery #) #) The manuscript is dedicated to Prof. Dr. Z. Halloul
Journal Title: Polish Journal of Surgery - Year 2018, Vol 90, Issue 3
Abstract
Introduction: Chylous complications, which occur also in the profile of vascularsurgical interventions with considerable frequency, are challenging with regard to their adequate management. Aim & method: Compact short overview on epidemiological, classifying, symptomatic, diagnostic and therapeutic aspects of chylous complications in vascular surgery, based on i) own clinical experiences, ii) a current selection of relevant scientific references and iii) representative case reports from clinical practice. Results (complex patient- & clinical finding-associated aspects): - Basic treatment of lymphedema / postreconstructive edema comprises the complex physical therapy to improve edematous swelling, which need to be usually performed over years. - In case of lymphocele, wait-and-see strategy can be initially pursued to observe spontaneous clinical course. If the lymphocele and its clinical complaints persist, puncture, placement of a drainage or temporary instillation of doxycyclin or ethanol can be attempted. - In case of lymphatic fistula, vacuum-assisted closure dressing, radiation and selective ligation of lymphatic vessels after previous application of methylen blue dye can be used. - Chylascites and chylothorax should be primarily treated – as have been widely established in the mean time – with a consequently conservative approach comprising initially paracentesis / thoracocentesis, protein-enriched and low-fat diet containing middle chain triglycerides (MCT) or total parenteral nutrition combined with the application of a somatostatin analogue (surgical approach as ultima ratio only aiming at ligation of the lesioned lymphatic vessel – if necessary, including preoperative consumption of cream). Summary: Chylous complications can be primarily treated with conservatice measures, which should be exploited using a step-wise approach prior to surgical intervention as ultima ratio. Conclusion: The experienced vascular surgeon should be aquainted with a sufficient, finding-adapted management of chylous complications. This requires a well-experienced clinician and surgeon with great expertise regarding the interdisciplinary setting comprising of interventional radiology, vascular (abdominal) surgery and partially surgical intensive care.<br/><br/>
Authors and Affiliations
Udo Barth, Klaus Wasseroth, Volker Rahms, Roland Albrecht, Frank Meyer
Keywords
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- EP ID EP345909
- DOI 10.5604/01.3001.0011.8172
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