Non-obstructive lymphoedema of the lower limbs (chyledema). Chyle reflux syndrome

its surgical importance

Abstract

A special type of non obstructive primary lymphoedema of the lower extremities is analysed. In this form, unilateral or bilateral varicose main lymphatic trunks of the lower extremities and abdomen below the cisterne chyli are present. There is also agenesia of the inguinal, iliac, lumbar and aortic ganglions and drainage is performed by non valvuletd
collectors. The important role of the cisterne chyliand the lymphatic ganglions of the system, which prevent backflow of lymph is emphatized. In case the ganglions are
absent and valvless channels are present, backflow syndrome of lymph in the lower extremities develops. Accoding this ethiology and phisiopathologie, the operation proposed by E. Tosatti, consisting in the excision of the suprainguinal coUectors seems logical. The first case of a lymph backflow syndrome in our country is presented. Diagnosis was made by lymphangiography, and Tosatti's operation performed by Dr. J. Mañana. The patient, male, ayed 15 years, developed a 2nd. degree lymphoedema of the right limb when he was 12 years old. The presence of inguinal ganglions on the left side prevented backflow and lymphoedema of the other limb. Post-operative evolution was excellent.