BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of ...BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.展开更多
BACKGROUND Chylous ascites(CA),which is characterized by lymphatic leakage into the peritoneal cavity,is a rare but significant complication of liver transplantation.Although dietary and pharmacological strategies hav...BACKGROUND Chylous ascites(CA),which is characterized by lymphatic leakage into the peritoneal cavity,is a rare but significant complication of liver transplantation.Although dietary and pharmacological strategies have shown effectiveness in managing CA,standardized treatment protocols have yet to be established.AIMTo evaluate the comparative effectiveness of low-fat diet (LFD) enriched with medium-chain triglycerides (MCTs)vs octreotide therapy in managing post-liver transplantation CA.METHODSA comprehensive literature review was conducted to analyze the outcomes of dietary interventions and octreotidetherapy. The key parameters examined included resolution rates, treatment duration, and recurrence.RESULTSA comprehensive literature search yielded 13 studies that met the inclusion criteria, comprising 4 retrospectivecohort studies and 8 case studies. The incidence of CA following liver transplantation ranges from 0.6% to 4.7%.The onset varied, with a median time to diagnosis of 10 days after transplantation. A LFD with MCT supplementationwas used as the first-line therapy in 83.3% of the studies, with resolution rates ranging from 62.5% to100%. Octreotide therapy was utilized in 66.7% of the studies, primarily as a second-line therapy, with resolutionrates of 83.3% to 100%. Combination therapy showed a significantly higher resolution rate than did dietarymanagement alone (97.8% vs 78.9%, P = 0.02). The time to resolution was significantly shorter with octreotidecontainingregimens than with dietary management alone (median, 7 days vs 14 days;P = 0.03).CONCLUSIONA stepwise approach to CA management is recommended, initiating dietary interventions and escalating tooctreotide when necessary. Further research through well-designed randomized controlled trials is essential toestablish standardized treatment protocols for optimizing patient outcomes.展开更多
Aim:We investigated the clinical application of autologous chyle fat in the correction of sunken upper eyelid.Methods:From November 2020 to October 2021,89 cases of correction with autologous chyle fat to sunken upper...Aim:We investigated the clinical application of autologous chyle fat in the correction of sunken upper eyelid.Methods:From November 2020 to October 2021,89 cases of correction with autologous chyle fat to sunken upper eyelid were performed(with or without other cosmetic procedures related to the eyes).An appropriate amount of fat was extracted from the superficial layer of the patient’s thigh and processed to chyle fat.About 0.5-2.8 mL of fat was injected under the orbicularis oculi muscle(roof-retro orbicularis oculi fat)or in the area where the orbital septal fat exists from the outer orbital margin of the upper eyelid.Results:In total,59 patients were followed up for 1-11 months after surgery.No infection,necrosis,vascular embolism,upper eyelid lumpiness,fat calcification,or liquefaction occurred in all patients,while seven cases showed inadequate correction.The depression basically disappeared,the shape was relatively full,the youthfulness was greatly improved,and the satisfaction of patients was high during the follow-up period.Conclusion:The correction with autologous chyle fat to sunken upper eyelid showed little trauma,short recovery periods,and satisfactory results,and it is worthy of being popularized and applied more widely.展开更多
Axillary lymph node dissection-dependent chyle leakage is a rare complication with an incidence of<0.7%.The morbidity could be high,and the management prolonged and not clear.The literature offers us many therapeut...Axillary lymph node dissection-dependent chyle leakage is a rare complication with an incidence of<0.7%.The morbidity could be high,and the management prolonged and not clear.The literature offers us many therapeutical tools,yet there is no consensus about the management of this complication.Usually,the management focuses on reducing the chyle flow in the thoracic duct(central origin),neglecting the possibility of a parallel lymphorrhea from other regional lymphatic vessels(peripheral origin),which causes a prolonged approach with high morbidity.In this paper,we introduce the supermicrosurgery technique as a surgical therapeutic option for chyle leakage.To decrease morbidity and shorten treatment duration,we offer a therapeutic algorithm based on the literature and our experience.展开更多
文摘BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.
文摘BACKGROUND Chylous ascites(CA),which is characterized by lymphatic leakage into the peritoneal cavity,is a rare but significant complication of liver transplantation.Although dietary and pharmacological strategies have shown effectiveness in managing CA,standardized treatment protocols have yet to be established.AIMTo evaluate the comparative effectiveness of low-fat diet (LFD) enriched with medium-chain triglycerides (MCTs)vs octreotide therapy in managing post-liver transplantation CA.METHODSA comprehensive literature review was conducted to analyze the outcomes of dietary interventions and octreotidetherapy. The key parameters examined included resolution rates, treatment duration, and recurrence.RESULTSA comprehensive literature search yielded 13 studies that met the inclusion criteria, comprising 4 retrospectivecohort studies and 8 case studies. The incidence of CA following liver transplantation ranges from 0.6% to 4.7%.The onset varied, with a median time to diagnosis of 10 days after transplantation. A LFD with MCT supplementationwas used as the first-line therapy in 83.3% of the studies, with resolution rates ranging from 62.5% to100%. Octreotide therapy was utilized in 66.7% of the studies, primarily as a second-line therapy, with resolutionrates of 83.3% to 100%. Combination therapy showed a significantly higher resolution rate than did dietarymanagement alone (97.8% vs 78.9%, P = 0.02). The time to resolution was significantly shorter with octreotidecontainingregimens than with dietary management alone (median, 7 days vs 14 days;P = 0.03).CONCLUSIONA stepwise approach to CA management is recommended, initiating dietary interventions and escalating tooctreotide when necessary. Further research through well-designed randomized controlled trials is essential toestablish standardized treatment protocols for optimizing patient outcomes.
文摘Aim:We investigated the clinical application of autologous chyle fat in the correction of sunken upper eyelid.Methods:From November 2020 to October 2021,89 cases of correction with autologous chyle fat to sunken upper eyelid were performed(with or without other cosmetic procedures related to the eyes).An appropriate amount of fat was extracted from the superficial layer of the patient’s thigh and processed to chyle fat.About 0.5-2.8 mL of fat was injected under the orbicularis oculi muscle(roof-retro orbicularis oculi fat)or in the area where the orbital septal fat exists from the outer orbital margin of the upper eyelid.Results:In total,59 patients were followed up for 1-11 months after surgery.No infection,necrosis,vascular embolism,upper eyelid lumpiness,fat calcification,or liquefaction occurred in all patients,while seven cases showed inadequate correction.The depression basically disappeared,the shape was relatively full,the youthfulness was greatly improved,and the satisfaction of patients was high during the follow-up period.Conclusion:The correction with autologous chyle fat to sunken upper eyelid showed little trauma,short recovery periods,and satisfactory results,and it is worthy of being popularized and applied more widely.
文摘Axillary lymph node dissection-dependent chyle leakage is a rare complication with an incidence of<0.7%.The morbidity could be high,and the management prolonged and not clear.The literature offers us many therapeutical tools,yet there is no consensus about the management of this complication.Usually,the management focuses on reducing the chyle flow in the thoracic duct(central origin),neglecting the possibility of a parallel lymphorrhea from other regional lymphatic vessels(peripheral origin),which causes a prolonged approach with high morbidity.In this paper,we introduce the supermicrosurgery technique as a surgical therapeutic option for chyle leakage.To decrease morbidity and shorten treatment duration,we offer a therapeutic algorithm based on the literature and our experience.
