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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 1999 March;18(1):10-3


language: English

Chylous reflux pathologies: diagnosis and microsurgical treatment

Campisi C., Boccardo F., Zilli A., Borrelli V.

From the Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplantation (DISCAT) Section of Emergency Surgical Clinic - Lymphangiology and Microsurgery Center University of Genoa, San Martino Hospital, Genoa, Italy


Background. This arti­cle aims to make a con­tri­bu­tion to the ­present knowl­edge of the diag­no­sis and ther­a­py of chy­lous ­reflux pathol­o­gies, based large­ly on the authors’ clin­i­cal expe­ri­ence in the micro­sur­gi­cal treat­ment of these dis­or­ders.
Methods. In 47 ­patients affect­ed by chy­los­tat­ic dis­or­ders the diag­no­sis was based on the clin­i­cal his­to­ry, phys­i­cal exam­ina­tion, lym­phos­cin­tig­ra­phy, lym­phog­ra­phy, ultra­sound, CT scan­ning and lym­phan­gio-MR. In cases of chy­lous ­reflux ­towards the exter­nal gen­i­tal­ia or the lower limbs, the punc­ture of one of the lym­phos­tat­ic ver­ru­cae which may be part of the symp­tom­a­tol­o­gy, can be suf­fi­cient for the clin­i­cal diag­no­sis. If ­patients suf­fer from hypo­pro­tei­nae­mia and/or an intes­ti­nal mal­ab­sorp­tion syn­drome, this ­should be dealt with to ­ensure them at least tem­po­rary meta­bol­ic com­pen­sa­tion ­before sur­gi­cal treat­ment, if any. In ­patients affect­ed by chy­lous ­ascites, anti­grav­i­ta­tion­al lig­a­tures of incom­pe­tent col­lec­tors, some­times asso­ciat­ed with lym­pho-­venous ­shunts, can be a ther­a­peu­tic solu­tion.
Results. We have found that CO2 laser irra­di­a­tion at very low power ­achieved full sec­tion clo­sure of lym­phat­ic and chy­lous ves­sels as com­plete as if they had been tied. In the case of chy­loe­de­ma of the exter­nal gen­i­tal­ia and of/or the lower limbs, reduc­tive plas­tic treat­ment com­pletes the ­result after anti­grav­i­ta­tion­al lig­a­tures and deriv­a­tive micro­sur­gery.
Conclusions. A laser-micro­sur­gi­cal tech­nique used to man­age chy­lous ­reflux pathol­o­gies ­achieved pos­i­tive and per­ma­nent ­results, espe­cial­ly after an accu­rate pre­op­er­a­tive diag­nos­tic study to deter­mine the site and ­nature of the lym­phat­ic and chy­lous leak­age and asso­ciat­ed dis­or­ders.

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