Successful surgical treatment of two cases of congenital chylous ascites

The authors report on 2 patients with congenital chylous ascites who underw ent successful lymphatic duct ligation after a laparoscopic lymphoid dye te st. Fetal ascites had been detected in both cases, and both babies were bor n with marked abdominal swelling. Given that conservative treatment by medi um-chain triglyceride (MCT) milk and total parenteral nutrition (TPN) was i neffective, the authors elected to perform lymphatic duct ligation on the 9 5th postnatal day in the former case and on the 27th postnatal day in the l atter case. Lipophilic dye was administered preoperatively both through ora l and subcutaneous routes, and the peritoneal cavity was explored using lap aroscopy. This laparoscopic lymphoid dye test precisely identified the area of chylous leakage, and the authors were able to repair the malformed lymp hatic duct directly at laparotomy. Both postoperative courses have been fav orable with no recurrence of symptoms. The lymphatic duct ligation should b e considered in cases resistant to conservative treatment for over a month. The present laparoscopic lymphoid dye test is a novel and useful procedure that allows surgeons to identify the exact location of chylous leakage, an d thus successfully ligate the lymphatic duct. J Pediatr Surg 36:1717-1719. Copyright (C) 2001 by W.B. Saunders Company.