Retroperitoneal exploration with Vicryl mesh and fibrin tissue sealant for refractory chylous ascites
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In brief
In brief
Case series of 4 neonates with refractory chylous ascites treated via complete retroperitoneal exploration using alternating layers of fibrin glue and Vicryl mesh. All patients achieved resolution without reoperation, reaching enteral feeds at median 29 days and discharge at 42 days postoperatively.
Written by the GCMD Library team from the article.
Background
Congenital chylous ascites poses a significant challenge in neonatal care, and often results in prolonged, complex hospital stays and increased mortality. Few effective options exist in refractory cases.
Methods
Patients aged 0 to 12 months with refractory chylous ascites underwent retroperitoneal exploration after medical treatment and minimally invasive therapies were unsuccessful. The retroperitoneum was completely exposed via left and right medial visceral rotation and opening the lesser sac. Visible leaks were ligated, and alternating layers of fibrin glue and Vicryl mesh were used to cover the entire retroperitoneum.
Results
All 4 patients had resolution of their chylous ascites. None required reoperation or reintervention for chyle leaks. All achieved goal enteral feeds at a median of 29 days postoperatively and were discharged from hospital at a median of 42 days postoperatively.
Conclusions
Management of chylous ascites is extremely challenging in refractory cases. Complete retroperitoneal exposure with fibrin glue and Vicryl mesh application offers a definitive, reliable therapy for achieving cessation of lymphatic leakage and ultimate recovery for patients who fail all nonoperative approaches.
Study type
Therapeutic.
Level of evidence
IV