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CASE REPORT article

Front. Med.
Sec. Hepatobiliary Diseases
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1420157
This article is part of the Research Topic Case Reports in Hepatobiliary Diseases View all articles

Refractory Massive Chylothorax Following Robot-Assisted Laparoscopic Splenectomy with Pericardial Devascularization Treated with Trans-jugular Intrahepatic Portosystemic Shunt: A Case Report

Provisionally accepted
Xiang Deng Xiang Deng *Jun Xia Jun Xia
  • Department of Abdominal Surgery, Guiqian International General Hospital, Guiyang, China

The final, formatted version of the article will be published soon.

    The development of a chylothorax after robot-assisted laparoscopic splenectomy combined with pericardial devascularization (LSPD) is rare. The robot-assisted procedure is similar to the standard LSPD, but surgeons must remain vigilant about potential chylothorax caused by recurrence of portal hypertension in patients with cirrhosis, an event that leads to variceal bleeding in the gastric fundus or a massive chylothorax caused by a thoracic duct fistula. We report a rare case of massive chylothorax after robot-assisted LSPD and review the literature to help elucidate the mechanisms of portal hypertension after LSPD, reduce surgical complications, and improve long-term patient outcomes. After LSPD, portal pressure monitoring, coagulation function testing, and portal vein CT imaging help in excluding portal vein thromboses and ensuring appropriate anticoagulation to reduce the development of thoracic duct fistulas. If portal hypertension recurs after surgery and a highoutput chylothorax develops, conservative treatment becomes ineffective. Treatment with an active trans-jugular intrahepatic portosystemic shunt (TIPS) is recommended to lower the portal pressure.

    Keywords: LSPD, portal hypertension, gastric fundus varices, massive chylothorax, tips

    Received: 19 Apr 2024; Accepted: 12 Aug 2024.

    Copyright: © 2024 Deng and Xia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Xiang Deng, Department of Abdominal Surgery, Guiqian International General Hospital, Guiyang, China

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