A novel minimally invasive surgical technique (LONG procedure) for treating chylopericardium

Background: Chylopericardium is a rare disease resulting from lymphatic system dysfunction and characterized by recurrent chylous pericardial effusion and cardiac compression. Traditional treatments like fasting, somatostatin injection and ligation of pericardial lymphatic vessels are less effective, with high recurrence rate. Fenestration is regarded as the last resort for treating chylopericardium. Our team designed a novel minimally invasive pericardial fenestration surgical technique (LONG procedure) for the treatment of chylopericardium. This study assessed its efficacy and technical characteristics, with the aim of providing valuable insights into the surgical treatment and management of chylopericardium. Methods: The clinical data of 7 patients with chylopericardium treated by the LONG procedure in the lymphatic surgery department from January 2018 to June 2024 were retrospectively analyzed. The data included the patients' medical history, imaging examination, pericardial effusion analysis, operative details, drainage output, length of hospital stay, and follow-up results. The indicators were analyzed to assess the technical characteristics of the LONG procedure. Results: Seven male patients aged between 7 and 35 years were enrolled in this study. The duration of the disease course ranged from 3 months to 10 years. All patients had previously accepted pericardial drainage, a fat-free diet, and anti-infection treatments. Some patients had also undergone thoracic duct adhesiolysis, embolization, or lymphatic ligation; however, they experienced recurrent pericardial effusion. Upon admission, all patients presented with at least moderate volumes of pericardial effusion. The LONG procedure was successfully performed on all patients, with an operation time of 54 to 95 minutes and minimal intraoperative blood loss (1-5 mL). Chest tubes were removed once the drainage became clear, typically between 15 to 37 days postoperation. Patients were discharged after 1-2 weeks of observation, with no recurrence or complications observed during the follow-up period of up to 5 years. Conclusions: The LONG procedure seems to be effective for the treatment of chylopericardium with low postoperative recurrence rates, but more research and long-term observation are needed.