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Thoracic Duct Lymphovenous Bypass for Central Lymphatic Dysfunction: A Systematic Review of Indications, Techniques, and Outcomes
Timothy Jiang
*1, Charbel Saad
2, Dany Y. Matar
2, Hooman Soltanian
2, Robin Yang
2, Salih Colakoglu
21University of Maryland School of Medicine, Baltimore , MD; 2Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
Background:
Central lymphatic dysfunction, from obstruction or malformation, leads to serious issues like chylothorax, chylous ascites, and protein-losing enteropathy, especially in pediatric/congenital cases. Thoracic duct lymphovenous bypass (TDLVB) is a microsurgical option for patients unresponsive to conservative or ablative treatments. This review assesses TDLVB's indications, techniques, and outcomes.
Methods:
A systematic search (PubMed, Embase, Cochrane, Scopus; since 2000) identified 19 studies on TDLVB involving 59 patients with documented preoperative imaging and post-surgical outcomes. Data were synthesized and analyzed for predictors of outcomes, complications, and reintervention.
Results:
Patients ranged from neonates to 74-year-olds, with nearly equal adult and pediatric representation. Common indications included chylothorax (68%), chylous ascites (36%), and generalized lymphedema (36%). Etiologies were predominantly congenital (46%), followed by iatrogenic (25%) and thrombotic (14%). TDLVB was often performed as salvage therapy after failure of conventional management. Overall clinical improvement or resolution occurred in 54% of cases, with a 42% confirmed anastomotic patency rate. Complications occurred in 29%, and 15% required reintervention. Protein-losing enteropathy predicted poorer outcomes (p=0.014), while chylous ascites correlated with higher complication rates (p=0.001). Use of anastomotic couplers was significantly associated with complications (p<0.001).
Conclusion:
TDLVB is a feasible reconstructive option for complex central lymphatic disorders, providing clinical benefit for select patients. Outcomes are influenced by etiology and individual lymphatic dynamics. Despite its potential, the procedure carries notable risks and variable success, highlighting the need for standardized protocols and prospective, multicenter trials to improve patient selection and refine techniques.
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