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- Title
Surgical creation of lymphocutaneous fistulas for the management of infants with central lymphatic obstruction.
- Authors
Laje, Pablo; Smood, Benjamin; Smith, Christopher; Pinto, Erin; Krishnamurthy, Ganesh; Taha, Dalal; Dori, Yoav; Maeda, Katsuhide
- Abstract
Purpose: Central lymphatic obstructions are associated with anasarca and high mortality. We hypothesized that opening dilated cutaneous lymphatic channels by creating a lymphocutaneous fistula (LCF) would decompress the lymphatic circulation and improve anasarca. Methods: We reviewed all patients that had at least one LCF created between 9/2019 and 12/2022. LCF efficacy was determined by changes in weight, urine/diuresis, ventilation, and clinical status. Results: We created eleven LCFs in four infants. LCFs initially drained 108 cc/kg/d (IQR68–265 cc/kg/d). Weights significantly decreased after LCF creation (6.9 [IQR6.1–8.1] kg vs. 6.1 [IQR 4.9–7.6] kg, P = 0.042). Ventilatory support decreased significantly in all patients after at least one LCF was created, and 3/4 patients (75%) had significantly lower peak inspiratory pressures (28 [IQR 25–31] cmH2O vs. 22 [IQR 22–24] cmH2O, P = 0.005; 36 [IQR36–38] cmH2O vs. 33 [IQR 33–35] cmH2O, P = 0.002; 36 [IQR 34–47] cmH2O vs. 28 [28–31] cmH2O, P = 0.002). LCFs remained patent for 29d (IQR 16–49d). LCFs contracted over time, and 6/11 (54.5%) were eventually revised. There were no complications. Two patients died from overwhelming disease, one died from unrelated causes, and one remains alive 29 months after their initial LCF. Conclusion: LCFs provide safe and effective temporary lymphatic decompression in patients with central lymphatic obstruction. While LCFs are not a cure, they can serve as a bridge to more definitive therapies or spontaneous lymphatic remodeling. Level of evidence: IV.
- Subjects
LYMPHEDEMA; INFANTS; FISTULA; POSITIVE pressure ventilation; LYMPHANGIOGRAPHY; EDEMA; DIURESIS
- Publication
Pediatric Surgery International, 2023, Vol 39, Issue 1, p1
- ISSN
0179-0358
- Publication type
Article
- DOI
10.1007/s00383-023-05532-9