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Fibrin glue application in the management of refractory chylous ascites in children
1Department of Pediatric Surgery, Hôpital Timone-Enfants, Marseille, France. smartzeidan@gmail.com
Insights
Fibrin glue application, often with absorbable mesh, effectively controls chylous ascites in children when conservative methods fail. Repeat applications may be necessary for complete resolution.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Chylous ascites is a rare condition characterized by lymphatic fluid accumulation in the abdomen.
- It often presents a management challenge, particularly when refractory to conservative treatments.
- Surgical intervention is sometimes required for persistent cases.
Purpose of the Study:
- To evaluate the efficacy of fibrin glue application in managing chylous ascites in pediatric patients.
- To assess the safety and effectiveness of fibrin glue in controlling lymphatic leakage.
- To explore its potential as a preventive measure for postoperative chylous ascites.
Main Methods:
- Retrospective chart review of 6 pediatric patients with refractory chylous ascites (1993-2006).
- Surgical exploration to identify and address diffuse lymphatic leakage.
- Application of fibrin glue, with absorbable mesh in later cases, to leakage zones.
Main Results:
- Immediate ascites control in 2 patients, within 3 weeks in 2 others.
- Two patients required repeat surgery for persistent lymphatic leakage.
- Mean follow-up of 4.3 years revealed two mild late recurrences, managed conservatively.
Conclusions:
- Fibrin glue application, especially with absorbable mesh, is a safe and effective surgical option for chylous ascites.
- Repeat surgical intervention with fibrin glue may be necessary for complete ascites control.
- Consideration of fibrin glue as a prophylactic measure against postoperative chylous ascites is warranted.
Abstract:
The purpose of this retrospective review of the charts of 6 children who underwent surgical treatment of chylous ascites refractory to conservative measures between 1993 and 2006 was to evaluate the efficiency of fibrin glue application for control of lymph leakage. Five children had postoperative chylous ascites (neuroblastoma, 4; cystic lymphangioma, 1) and 1 had a congenital malformation. Surgical exploration revealed large areas of diffuse lymphatic leakage in all of the patients. Lymphatic fistula was not identified intraoperatively in any patient. Ingestion of lipophilic dye in a concentrated fatty meal was not helpful in locating a lymph fistula. Absorbable mesh was used in association with glue application in the last 3 patients treated. Control of ascites was achieved immediately in 2 patients and within 3 weeks in 2 patients. Repeat surgery was required in the remaining 2 patients. The mean follow-up time was 4.3 years. One patient died of tumor recurrence 12 months after surgical treatment without relapse of the ascites. Two mild late recurrences were observed at 6 and 11 months after surgery and were managed conservatively. The findings of this study show that fibrin glue application on absorbable mesh after dissection of the leakage zones is easy, safe, and effective. We recommend that surgery with glue application be repeated until control of ascites is achieved. We suggest fibrin glue application as a preventive measure against postoperative chylous ascites.
