Mesenteric lymphatic ligation in the prevention of chylous fistulae in abdominal neuroblastoma surgery

Purpose We evaluated the effectiveness of prophylactic mesenteric lymphatic ligation in preventing iatrogenic chylous fistulae in abdominal neuroblastoma surgery. Method All patients who underwent resection of abdominal neuroblastoma between years 2002 and 2013 were included. A change in surgical st...

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Bibliographic Details
Published in:Pediatric surgery international 2014-10, Vol.30 (10), p.1009-1012
Main Author: Chui, Chan-Hon
Format: Article
Language:English
Subjects:
Adolescent
Child
Child, Preschool
Chyle
Cohort Studies
Digestive System Fistula - prevention & control
Female
Humans
Infant
Ligation
Male
Medicine
Medicine & Public Health
Neuroblastoma - surgery
Original Article
Pediatric Surgery
Pediatrics
Postoperative Complications - prevention & control
Retroperitoneal Neoplasms - surgery
Retrospective Studies
Surgery
Thoracic Duct - surgery
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Summary:Purpose We evaluated the effectiveness of prophylactic mesenteric lymphatic ligation in preventing iatrogenic chylous fistulae in abdominal neuroblastoma surgery. Method 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. Conclusion Chylous fistulae complicating abdominal neuroblastoma surgery disrupt neuroblastoma treatment. Meticulous MLL can be preventative if performed routinely before abdominal closure in the primary surgery.
ISSN:0179-0358
1437-9813
DOI:10.1007/s00383-014-3581-z