A systematic review of lymphovenous anastomosis to treat nontraumatic chylous anasarca

Anomalies in chyle flow, obstructive, functional or malformative, are responsible for leakage of chyle into the peritoneal, pericardial, or pleural spaces. Although rare, chronic chylous effusions can have disastrous consequences. Current treatments do not provide permanent and satisfactory solutions. Lymphovenous anastomosis can be a suitable treatment in this context; however, it needs to be fully evaluated regarding its efficacy, indications, and means of achievements. The objective of the study is to assess the efficacy of lymphovenous anastomosis to treat nontraumatic chylous anasarca. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was made using PubMed, ScienceDirect, and the Cochrane library from databases creation to August 2024 to analyze all patients reported to have undergone lymphovenous anastomosis for nontraumatic chylous leakage. Quality assessment of studies was performed with Joanna Briggs Institute Manual for Evidence Synthesis assessment tools and Methodological Index for Non-Randomized Studies. Results were presented in table summaries. In total, 14 studies matching inclusion criteria (human subjects, articles in English or French, whose main subject was chylous effusion management) were identified (9 case reports, 5 case series), representing 48 patients treated via lymphovenous anastomosis. The indications reported were mostly thoracic duct obstruction or malformation. Lymphovenous anastomosis was at least partially successful in 35 patients (74%), the condition was completely resolved in 27 patients (57%). Only a few complications were reported. Lymphovenous anastomosis could be a suitable treatment for nontraumatic chylous effusions but requires further evaluation via prospective cohort studies with more patients to define indications and methods and evaluate long-term outcomes for better management.