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July 1966

Experimental Ascites: VII. The Effects of External Drainage of the Thoracic Duct on Ascites and Hepatic Hemodynamics

Arch Surg. 1966;93(1):119-130. doi:10.1001/archsurg.1966.01330010121015

SINCE THE observations of Starling in 1894,1 a number of studies have demonstrated a marked increase in the flow of lymph in the hepatic hilar lymphatics and thoracic duct in association with experimental ascites,2-5 hepatic venous outflow obstruction,6-8 and experimental cirrhosis.9-11 A similar increase in lymph flow in the thoracic duct has been observed recently in humans with cirrhosis,12-14 or congestive heart failure15; and the marked enlargement of the lymphatics in the hilum of the cirrhotic liver, so familiar to surgeons who have performed operations for portal hypertension, has been documented by a careful histopathologic study.16 Although the cause of the augmented production of hepatic lymph is not certain, the bulk of evidence indicates that it is in large part a mechanical phenomenon resulting from obstruction to the outflow of blood from the liver sinusoid and the consequent spill-over of the plasma portion