1
|
Kim HJ, Choi GS, Park JS, Park SY, Song SH, Lee SM, Jeong MH, Cho SH. Long-term Complications of Laparoscopic or Robotic Lateral Pelvic Node Dissection After Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer. Dis Colon Rectum 2024; 67:505-513. [PMID: 38164944 DOI: 10.1097/dcr.0000000000003183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Patients with rectal cancer who underwent lateral pelvic node dissection might be at a higher risk of postoperative complications derived from technical complexity. However, little is known regarding the long-term complications after lateral pelvic node dissection. OBJECTIVES The study aimed to investigate the long-term complications of preoperative chemoradiotherapy, followed by total mesorectal excision with lateral pelvic node dissection for locally advanced rectal cancers. DESIGN A retrospective analysis of a prospectively collected database. SETTINGS This study was conducted in a tertiary cancer center. PATIENTS Patients with rectal cancer who underwent total mesorectal excision with lateral pelvic node dissection after preoperative chemoradiotherapy between 2011 and 2019 were analyzed. All operations were performed via a laparoscopic or robotic approach. MAIN OUTCOME MEASURES Long-term complications were defined as adverse events that persisted or newly appeared ≥90 days after surgery and could be related to the surgery. RESULTS A total of 164 patients underwent total mesorectal excision with lateral pelvic node dissection after preoperative chemoradiotherapy. Short-term and long-term complication rates were 36.0% and 36.6%, respectively. Lymphocele was the most common long-term complication (17.7% of patients), and 11.6% had anastomotic leakage with chronic sinus. Of the patients with long-term complications, 20.7% of patients needed readmission for treatment. Of the 29 patients with lymphocele, 13 (41.0%) experienced spontaneous absorption and 11 (37.9%) required surgical or percutaneous catheter drainage or antibiotics use. Multivariate analysis showed pathologic pelvic node metastases ( p = 0.008), and a higher number of unilateral harvested pelvic nodes ( p = 0.001) were significantly associated with long-term complications. At the last follow-up (median duration of 43 months), 15.9% of patients had unresolved complications. LIMITATIONS The retrospective design. CONCLUSIONS Patients undergoing lateral pelvic node dissection experienced a higher frequency of long-term complications, but half of them had asymptomatic lymphoceles, most of which resolved spontaneously. However, further efforts should be paid to reduce anticipated complications related to lateral pelvic node dissection. See Video Abstract . COMPLICACIONES A LARGO PLAZO DE LA DISECCIN DE LOS GANGLIOS LIFTICOS PLVICOS LATERALES LAPAROSCPICA O ROBTICA DESPUS DE LA QUIMIORRADIOTERAPIA PREOPERATORIA CONTRA EL CNCER DEL RECTO LOCALMENTE AVANZADO ANTECEDENTES:Los pacientes con cáncer del recto sometidos a disección ganglionar linfática pélvica lateral podrían tener mayor riesgo de complicaciones postoperatorias derivadas de la complejidad técnica. Sin embargo, se sabe poco sobre las complicaciones a largo plazo después de la disección de los ganglios linfáticos pélvicos laterales.OBJETIVOS:Investigar las complicaciones a largo plazo de la quimiorradioterapia preoperatoria, seguida de escisión mesorrectal total con disección de los ganglios linfáticos pélvicos laterales contra el cáncer de recto localmente avanzado.DISEÑO:Un análisis retrospectivo de una base de datos recopilada prospectivamente.AJUSTES:Este estudio se llevó a cabo en un centro oncológico terciario.PACIENTES:Se analizaron pacientes con cáncer de recto que se sometieron a escisión mesorrectal total con disección de ganglios linfáticos pélvicos laterales después de quimiorradioterapia preoperatoria entre 2011 y 2019. Todas las operaciones se realizaron mediante abordaje laparoscópico o robótico.PRINCIPALES MEDIDAS DE RESULTADO:Las complicaciones a largo plazo se definieron como eventos adversos que persistieron o aparecieron recientemente ≥ 90 días después de la cirugía y podrían estar relacionados con la cirugía.RESULTADOS:Un total de 164 pacientes se sometieron a escisión mesorrectal total con disección de los ganglios linfáticos pélvicos laterales después de quimiorradioterapia preoperatoria. Las tasas de complicaciones a corto y largo plazo fueron del 36,0% y 36,6%, respectivamente. El linfocele fue la complicación a largo plazo más común (17,7% de los pacientes) y el 11,6% tuvo fuga anastomótica con seno crónico. De los pacientes con complicaciones a largo plazo, el 20,7% de los pacientes necesitaron reingreso para recibir tratamiento. De 29 pacientes con linfocele, 13 (41,0%) experimentaron absorción espontánea y 11 (37,9%) requirieron drenaje quirúrgico o percutáneo con catéter o uso de antibióticos. El análisis multivariado mostró metástasis patológicas en los ganglios linfáticos pélvicos ( p = 0,008) y un mayor número de ganglios pélvicos extraídos unilateralmente ( p = 0,001) se asociaron significativamente con complicaciones a largo plazo. En el último seguimiento (mediana de 43 meses), el 15,9% de los pacientes tuvieron complicaciones no resueltas.LIMITACIÓN:El diseño retrospectivo.CONCLUSIONES:Los pacientes sometidos a disección de ganglios pélvicos linfáticos laterales experimentaron una mayor frecuencia de complicaciones a largo plazo, pero la mitad de ellos tuvieron linfoceles asintomáticos, la mayoría de los cuales se resolvieron espontáneamente. Sin embargo, se deben realizar mayores esfuerzos para reducir las complicaciones previstas relacionadas con la disección de los ganglios linfáticos pélvicos laterales. (Traducción-Dr. Aurian Garcia Gonzalez ).
Collapse
Affiliation(s)
- Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Ho Song
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Min Lee
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min Hye Jeong
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
2
|
Ay N, Alp V, Duymuş R, Çetin S. Lymphocele Outcomes After Renal Transplantations Performed by an Experienced Surgeon: Is Meticulously Performed Surgery and Experience Adequate to Prevent Lymphocele? Ann Transplant 2024; 29:e942656. [PMID: 38374615 PMCID: PMC10893763 DOI: 10.12659/aot.942656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The purpose of the present study was to analyze the rate of lymphoceles in kidney transplant operations meticulously performed by the same senior surgeon. MATERIAL AND METHODS The present study included 315 patients who were operated on in our organ transplantation center and followed up in the polyclinic after July 2013. The patients were retrospectively divided into 2 groups: patients with and without lymphocele. Symptomatic lymphocele (SL) has been defined as symptomatic fluid collection around the graft that necessitates an intervention for the graft or patient. RESULTS Lymphocele was observed in 82 (26%) patients. An intervention was needed in 16 (5.1%) of these cases. Demographic data such as age and sex of both groups were similar. Lymphocele cases were mostly asymptomatic, with a size <6 cm (75.6%). However, intervention was needed in 16 (75%) of the patients with a size ≥6 cm that were symptomatic. The length of time on dialysis in the pretansplant period was shorter in the group that developed lymphocele, and a lower rate of graft loss was observed in these patients. No statistically significant difference was found between the 2 groups in terms of rejection rates, serum albumin/globulin levels, and development of de novo DSA. CONCLUSIONS The risk factors reported in the literature related with lymphocele formation were not found to be statistically significant in our study. Complications, except lymphocele, were observed less frequently, but lymphocele formation was encountered in our patients despite meticulous surgery.
Collapse
Affiliation(s)
- Nurettin Ay
- Transplantation Center/General Surgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Vahhac Alp
- Transplantation Center/General Surgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Recai Duymuş
- Department of Radiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Sedat Çetin
- Department of Internal Medicine, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| |
Collapse
|
3
|
May M, Gilfrich C, Bründl J, Ubrig B, Wagner JR, Gloger S, Student V, Merseburger AS, Thomas C, Brookman-May SD, Wolff I. Impact of Peritoneal Interposition Flap on Patients Undergoing Robot-assisted Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Focus 2024; 10:80-89. [PMID: 37541915 DOI: 10.1016/j.euf.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
CONTEXT Symptomatic lymphocele (sLC) occurs at a frequency of 2-10% after robot-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND). Construction of bilateral peritoneal interposition flaps (PIFs) subsequent to completion of RARP + PLND has been introduced to reduce the risk of lymphocele, and was initially evaluated on the basis of retrospective studies. OBJECTIVE To conduct a systematic review and meta-analysis of only randomized controlled trials (RCTs) evaluating the impact of PIF on the rate of sLC (primary endpoint) and of overall lymphocele (oLC) and Clavien-Dindo grade ≥3 complications (secondary endpoints) to provide the best available evidence. EVIDENCE ACQUISITION In accordance with the Preferred Reporting Items for Meta-Analyses statement for observational studies in epidemiology, a systematic literature search using the MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE databases up to February 3, 2023 was performed to identify RCTs. The risk of bias (RoB) was assessed using the revised Cochrane RoB tool for randomized trials. Meta-analysis used random-effect models to examine the impact of PIF on the primary and secondary endpoints. EVIDENCE SYNTHESIS Four RCTs comparing outcomes for patients undergoing RARP + PLND with or without PIF were identified: PIANOFORTE, PerFix, ProLy, and PLUS. PIF was associated with odds ratios of 0.46 (95% confidence interval [CI] 0.23-0.93) for sLC, 0.51 (95% CI 0.38-0.68) for oLC, and 0.41 (95% CI 0.21-0.83) for Clavien-Dindo grade ≥3 complications. Functional impairment resulting from PIF construction was not observed. Heterogeneity was low to moderate, and RoB was low. CONCLUSIONS PIF should be performed in patients undergoing RARP and simultaneous PLND to prevent or reduce postoperative sLC. PATIENT SUMMARY A significant proportion of patients undergoing prostate cancer surgery have regional lymph nodes removed. This part of the surgery is associated with a risk of postoperative lymph collections (lymphocele). The risk of lymphocele can be halved via a complication-free surgical modification called a peritoneal interposition flap.
Collapse
Affiliation(s)
- Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany.
| | - Christian Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Burkhard Ubrig
- Center for Minimally Invasive and Robotic Urology, Augusta Hospital Bochum, Witten/Herdecke University, Bochum, Germany
| | - Joseph R Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, USA
| | - Simon Gloger
- Center for Minimally Invasive and Robotic Urology, Augusta Hospital Bochum, Witten/Herdecke University, Bochum, Germany
| | - Vladimir Student
- Department of Urology, University Hospital Olomouc, Olomouc, Czechia
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, University Hospital of the Technical University of Dresden, Dresden, Germany
| | - Sabine D Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University, Munich, Germany; Janssen Pharma Research and Development, Spring House, PA, USA
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
4
|
Mitsui K, Narushima M, Danno K, Ishiura R, Banda CH. Intra-lymphocele microsurgical identification of causative afferent vessels for effective lymphaticovenular anastomosis in lymphocele treatment: A case report. Microsurgery 2024; 44:e31002. [PMID: 36571804 DOI: 10.1002/micr.31002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022]
Abstract
Lymphoceles are an important complication of pelvic and abdominal surgery with a reported incidence of 11%-88%. Conventional treatment includes compression, puncture aspiration, sclerotherapy, and ligation but recurrence is not uncommon and is difficult to treat. Recently, microsurgical lymphaticolymphatic anastomosis, lymphaticovenular anastomosis (LVA) and reconstruction of lymphatic circulation with flaps are increasingly being utilized for lymphocele treatment. Effective microsurgical treatment requires precise identification of the causative afferent vessels for the most efficient circulatory by-pass. However, direct identification of these vessels using traditional lymphoscintigraphy and near infrared lymphography is challenging and often not possible. We report the case of a 55-year-old woman who presented with bilateral inguinal lymphoceles and lymphedema following pelvic surgery for vulvovaginal cancer. Bilateral multiple LVAs of the lower extremities were performed and the lower limb circumferences reduced postoperatively, however both lymphoceles still persisted. The patient was successfully treated by approaching the lymphoceles from inside the lymphocele cavity. The causative afferent lymph vessels were directly identified microsurgically by gentle pressure on the inner wall and causative afferent lymph vessel lymphaticovenular anastomosis was performed. The lymphoceles resolved promptly after surgery without complications, and no recurrence was observed on 5 years follow-up. This case report presents an innovative microsurgical approach to lymphocele treatment, including examination and techniques to identify the causative afferent lymphatic vessels for effective anastomosis. We report this case to demonstrate the importance of lymphatic vessel selection in the microsurgical treatment of lymphocele.
Collapse
Affiliation(s)
- Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| |
Collapse
|
5
|
Togami S, Fukuda M, Mizuno M, Yanazume S, Kobayashi H. Efficacy and prognosis of robotic surgery with sentinel node navigation surgery in endometrial cancer. J Gynecol Oncol 2023; 34:e68. [PMID: 37293801 PMCID: PMC10627747 DOI: 10.3802/jgo.2023.34.e68] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/16/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE This study aimed to validate the surgical and oncologic outcomes of robotic surgery with sentinel node navigation surgery (SNNS) in endometrial cancer. METHODS This study included 130 patients with endometrial cancer, who underwent robotic surgery, including hysterectomy, bilateral salpingo-oophorectomy, and pelvic SNNS at the Department of Obstetrics and Gynecology of Kagoshima University Hospital. Pelvic sentinel lymph nodes (SLNs) were identified using the uterine cervix 99m Technetium-labeled phytate and indocyanine green injections. Surgery-related and survival outcomes were also evaluated. RESULTS The median operative and console times and volume of blood loss were 204 (range: 101-555) minutes, 152 (range: 70-453) minutes, and 20 (range: 2-620) mL, respectively. The bilateral and unilateral pelvic SLN detection rates were 90.0% (117/130) and 5.4% (7/130), respectively, and the identification rate (the rate at which at least one SLN could be identified on either side) was 95% (124/130). Lower extremity lymphedema occurred in only 1 patient (0.8%), and no pelvic lymphocele occurred. Recurrence occurred in 3 patients (2.3%), and the recurrence site was the abdominal cavity, with dissemination in 2 patients and vaginal stump in one. The 3-year recurrence-free survival and 3-year overall survival rates were 97.1% and 98.9%, respectively. CONCLUSION Robotic surgery with SNNS for endometrial cancer showed a high SLN identification rate, low occurrence rates of lower extremity lymphedema and pelvic lymphocele, and excellent oncologic outcomes.
Collapse
Affiliation(s)
- Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Mika Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Mika Mizuno
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
| |
Collapse
|
6
|
Di Gianfrancesco L, Alessandro C, Paolo C, Davide DM, Eugenio M, Angelo P. Robot-Assisted Treatment of Symptomatic Lymphocele Postradical Prostatectomy and Lymphadenectomy in the Era or Robotic Surgery: Narrative Review. Technol Cancer Res Treat 2023; 22:15330338221145248. [PMID: 37350154 PMCID: PMC10291396 DOI: 10.1177/15330338221145248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Background: Pelvic lymphnode dissection (PLND) is an integral part of surgical treatment for localized intermediate and high-risk prostate cancer. The most common complication of PLND is lymphocele formation. In the majority of cases the development of lymphoceles is clinically asymptomatic but in case of symptomatic/infected lymphocele an active treatment is required. The aim of this article is to analyse the current evidence on the treatment of symptomatic/infected lymphocele trough robotic approach. Materials and Methods: The search was applied to PubMed, EMBASE, and Cochrane databases with following terms: "lymphocele", "symptomatic", "infected", "robot-assisted AND radical prostatectomy", "robot-assisted", "treatment". Results: The search identified three series focusing on the treatment by robot-assisted approach of symptomatic and/or infected lymphocele. The main and most frequent reason for performing the robotic treatment was an infected lymphocele, the median time from robot-assisted radical prostatectomy and PLND to robotic treatment of lymphocele was 118 days (range 30-240). Robot-assisted treatment was successful in all reports. Conclusions: The drainage of lymphocele with the robot-assisted approach appeared safe, feasible, and with satisfactory outcomes for the definitive treatment of symptomatic/infected lymphocele.
Collapse
Affiliation(s)
- Luca Di Gianfrancesco
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| | - Crestani Alessandro
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| | - Corsi Paolo
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| | - De Marchi Davide
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| | - Miglioranza Eugenio
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| | - Porreca Angelo
- Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy at the headquarters of Castelfranco Veneto, Treviso, Italy
| |
Collapse
|
7
|
Simforoosh N, Basiri A, Tabibi A, Marufi H, Kashi AH. Comparing the Frequency of Lymphoceles Which Needed Intervention in Recipients of Living Donor Versus Deceased Donor Kidney Transplants. Urol J 2022; 19:228-231. [PMID: 35466394 DOI: 10.22037/uj.v19i.7050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE In this study, we aimed to compare the frequency of lymphoceles that needed intervention in recipients who received kidneys from living versus deceased donors. MATERIALS AND METHODS The records of all patients who underwent kidney transplantation at the Labbafinejad Hospital from 2012 to 2021 were retrospectively reviewed to determine the incidence of lymphoceles that needed intervention for management. RESULTS From March 2012 to April 2021, 1752 patients received kidney transplantation in Labbafinejad Hospital including 975 transplantations from living donors and 777 transplantations from deceased donors. Symptomatic lymphoceles were observed postoperatively in 23 patients. Symptoms included compressive effect on the ureter, hydroureteronephrosis of the transplanted kidney, frequency, urinary retention, infection, abdominal discomfort, or rise in serum creatinine. Out of 23 patients who needed intervention for symptomatic lymphocele, 15 patients were recipients of living donors and 8 patients were recipients of deceased donors [1.53% versus 1.03%, P=.40]. Intervention consisted of open surgical drainage in 6 patients [4 recipients of living donors and 2 recipients of deceased donors], and nephrostomy insertion in 17 patients. Open operation was necessary in 5 (47%) patients in whom arterial anastomosis was made to the internal iliac artery versus 1 (9%) patient in whom the anastomosis was not made to the internal iliac artery (P=0.15). CONCLUSION Symptomatic lymphoceles which needed intervention were observed in low frequency (1.31%). Most cases can be managed by endoscopic drainage without relapse. Type of donation had no relationship with the need for open or endoscopic intervention in lymphoceles. A higher proportion of open surgeries to control lymphocele were observed in recipients in whom the internal iliac artery was used for arterial anastomosis however the difference was not statistically significant.
Collapse
Affiliation(s)
- Nasser Simforoosh
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinajad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.
| | - Abbas Basiri
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinajad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.
| | - Ali Tabibi
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinajad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.
| | - Hamed Marufi
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinajad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.
| | - Amir Hossein Kashi
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinajad Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.
| |
Collapse
|
8
|
Kakubari R, Kobayashi E, Kakuda M, Iwamiya T, Takiuchi T, Kodama M, Hashimoto K, Ueda Y, Sawada K, Tomimatsu T, Kimura T. Postoperative lymphocyst formation after pelvic lymphadenectomy for gynecologic cancers: comparison between laparoscopy and laparotomy. Int J Clin Oncol 2022; 27:602-608. [PMID: 35119580 DOI: 10.1007/s10147-021-02052-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The goal of this study was to evaluate, using definitive diagnostic criteria, the incidence of lymphocyst formation following pelvic lymphadenectomy for gynecological cancer, and to compare rates between the approaches of laparoscopy and laparotomy. METHODS We retrospectively reviewed the medical records of all patients who underwent pelvic lymphadenectomy for cervical or endometrial cancer between March of 2010 and March of 2016. We defined a lymphocyst as a circumscribed collection of fluid within the pelvic cavity, with a diameter of 2 cm or more, as diagnosed with ultrasound or computed tomography. RESULTS During the six-year observational period, a pelvic lymphadenectomy was conducted in 196 women with clinical stage I uterine cancer; 90 cases underwent laparoscopy, 106 underwent laparotomy. The minimally invasive laparoscopic group had a lower estimated blood loss (p < 0.01), shorter hospital stay (p < 0.01). Lymphocysts were observed in 14.4% (13/90) of the laparoscopy cases, and in 15.1% (16/106) of the laparotomy cases which means no significant difference of lymphocyst (p = 1.00). The median size of symptomatic lymphocyst was significantly larger in laparotomy group than in laparoscopy group (4.8 cm v.s. 2.8 cm, median) (p = 0.04). Symptomatic lymphocysts were more common in laparotomy [7/90 (7.8%) vs 14/106 (13.2%) (p = 0.253)]. CONCLUSIONS In a retrospective analysis with a strict diagnostic criteria, we could find no statistical difference in lymphocyst occurrence between laparoscopy and laparotomy. The median size of the lymphocyst was bigger and lymphocyst was likely to be symptomatic in the laparotomy group.
Collapse
Affiliation(s)
- Reisa Kakubari
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan.
| | - Mamoru Kakuda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan
| | - Tadashi Iwamiya
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan
| | - Michiko Kodama
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan
| | - Kae Hashimoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan
| | - Kenjiro Sawada
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 565-0871 2-2, Yamadaoka, Suita City, Osaka, Japan
| |
Collapse
|
9
|
Khorshidi F, Majdalany BS, Peters G, Tran AN, Shaikh J, Liddell RP, Perez Lozada JC, Kokabi N, Nezami N. Minimally invasive treatment of abdominal lymphocele: A review of contemporary options and how to approach them. Lymphology 2021; 54:56-67. [PMID: 34735751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Lymphoceles are lymphatic fluid collections resulting from lymphatic vessel disruption after surgery or trauma. They are most often described following retroperitoneal surgeries such as cystectomies, prostatectomies, renal transplants, and gynecologic surgeries. Most lymphoceles are asymptomatic and resolve spontaneously without treatment. If persistent, they can become infected or exert mass effect on adjacent structures causing pain, urinary, or lower limb edema particularly for lymphoceles in the pelvis Symptomatic lymphoceles should be treated to relieve symptoms and prevent functional compromise of vital adjacent structures. Although surgery has been traditionally accepted as the gold standard treatment, advances in imaging and interventional technology allow for less invasive, percutaneous treatment. Available minimally invasive treatment options include percutaneous aspiration, catheter drainage, sclerotherapy, and lymphangiography with lymphatic embolization. A review of these treatment options and a suggested algorithm for managing lymphoceles is presented.
Collapse
Affiliation(s)
- F Khorshidi
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - B S Majdalany
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - G Peters
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - A N Tran
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - J Shaikh
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - R P Liddell
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - J C Perez Lozada
- Section of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - N Kokabi
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - N Nezami
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
10
|
Gabriele G, Tommasino G, Cascino F, Carangelo BR, Zerini F, Niccolai G, Del Frate R, Xu J, Gennaro P. Rare case of giant lymphocele treated with supramicrosurgical approach. Ann Ital Chir 2020; 91:S2239253X20033198. [PMID: 33337431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Lymphocele (or cystic lymphangioma) is a typical disease of the lymphatic vascukarization caused by lymphatic fluid leakage. Lymphatic leakage can result from traumas or as a complication of surgical procedures. Clinic is vague and surgical resection is still considered the most effective approach. Thereby, a standpoint should be the identification and treatment of afferent lymphatic channels which can be addressed by LVA. CASE PRESENTATION The authors describe a rare case of a giant lymphocele occurred in a 56-year-old Caucasian woman treated for endometrial carcinoma. Lymphocele was refractory to percutaneous drainage and compressive treatment. Therefore surgical excision in combination with supramicrosurgical lymphatico-venular anastomosis (LVA) was scheduled. CONCLUSIONS The aim of the report is to offer an overview on the main therapeutic options to treat lymphocele and to demonstrate the effectiveness of combining excision with lymphatic microsurgery. KEY WORDS Inguinal lymphocele, LVA, Supramicrosurgery.
Collapse
|
11
|
Luo X, Xie M, Ma Y, Jiang X. Anesthesia management of a premature neonate during minimally invasive sclerotherapy of a large chest wall mass: A case report. Medicine (Baltimore) 2020; 99:e21726. [PMID: 32846792 PMCID: PMC7447500 DOI: 10.1097/md.0000000000021726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 06/04/2020] [Accepted: 06/26/2020] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The most common critical incidents in pediatric anesthesia are perioperative respiratory adverse events (PRAE), which occur more often in neonates and account for one-third of anaesthesia-related cardiac arrests. It is crucial to maintain an open stable airway during anesthesia in neonates, as this population has a low oxygen reserve, small airways, and the loss of protective airway reflexes under general anesthesia. PATIENT CONCERNS A 6-day-old premature newborn underwent minimally invasive sclerotherapy under general anesthesia. For high-risk premature neonates, the selections of the anesthesia and airway device are extremely important, as those factors directly affect the prognosis. DIAGNOSES B ultrasound and computed tomography (CT) revealed a large mass from the left chest wall to axilla, which was suspected to be a lymphocele. INTERVENTIONS Minimally invasive sclerotherapy was performed under inhalation anesthesia. After the initiation of anesthesia, a laryngeal mask was placed to control airway. Anesthesia was maintained intraoperatively via sevoflurane inhalation with spontaneous breathing. No accidental displacements or PRAE occurred. OUTCOME The operation and anesthesia process was stable and safe. The patient discharged at 2 days postoperatively. LESSONS Minimally invasive sclerotherapy in a premature neonate is an operation with an extremely short operation time and minimal trauma, but a very high anesthesia risk and risk of PRAE. Anesthesia management is very important in a premature neonate undergoing a very short surgery under general anesthesia. Total sevoflurane inhalation general anesthesia and laryngeal mask airway control with spontaneous breathing may be an ideal option to reduce PRAE during very short surgery in a premature neonate.
Collapse
Affiliation(s)
- Xi Luo
- Department of Nursing, Sichuan Academy of medical Sciences and Sichuan Provincial People's Hospital
| | - Min Xie
- Department of Operating Room
| | - Yushan Ma
- Department of Anesthesiology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China
| | - Xiaoqin Jiang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China
| |
Collapse
|
12
|
Li W, Zhang X, Zhang T, Jiang J, He Z, Zhang X. Intravenous Lymphatic Cyst in Inferior Vena Cava-A Rare Cause of Budd-Chiari Syndrome. Ann Vasc Surg 2018; 57:274.e1-274.e3. [PMID: 30500636 DOI: 10.1016/j.avsg.2018.08.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 11/17/2022]
Abstract
A case with an extremely rare intravenous cystic lesion in the suprahepatic inferior vena cava was reported, which originated from the lymphatic system and had induced Budd-Chiari syndrome. To the best of our knowledge, this is the first report of a benign cystic lesion originating from the wall of a suprahepatic inferior vena cava which results in Budd-Chiari syndrome.
Collapse
Affiliation(s)
- Weihao Li
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China
| | - Xuemin Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China.
| | - Tao Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China
| | - Jingjun Jiang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China
| | - Zhibin He
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University Health Science Center, Peking University, Beijing, China
| |
Collapse
|
13
|
Abstract
The current report documents a case of lymphocele after neck dissection and reviews the management and treatment options.
Collapse
Affiliation(s)
- Johan Nouwen
- Department of Otorhinolaryngology-Head and Neck Surgery, Hôpital Européen Georges Pompidou, Assistance publique des hôpitaux de Paris, Université Paris V, Paris, France
| | | | | | | |
Collapse
|
14
|
Aurelus PJ, Ortiz RC, Rendón-Macías ME, Ortega-Rodríguez MC, De la Cruz-Yañiz H, Yamamoto-Nagano A, Torres-Díaz JS. [Lymphocele surgical treatment in pediatric kidney transplantation]. Rev Med Inst Mex Seguro Soc 2016; 54:142-145. [PMID: 26960039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND In a retrospective study, we evaluated; frequency, clinical presentation and treatment of lymphocele in pediatric patients with kidney transplant. METHODS Between January 2004 and January 2009, we had 242 kidney transplantations, 197 from living donors and 45 from cadaveric donors. The technique was the usual, and the implants of the ureteres were by the technique Ricard modified. The treatment of lymphocele was by percutaneous punction and laparoscopic intraperitoneal drainage. RESULTS We diagnosed lymphocele in seven patients (2.9 % with an IC95 %: 0.6- 5.2 %) one female and six males. All patients went trough percutaneous drainage. Six patients presented lymphocele recurrence at 48 to 72 hours after the drainage. Surgical laparoscopic intraperitoneal drainage was performed with success. CONCLUSIONS Our frequency of lymphocele is the same reported in other studies (6-18 %). The treatment by laparoscopic intraperitoneal window seems to be the most appropriate in pediatric patients.
Collapse
Affiliation(s)
- Pierre Jean Aurelus
- Servicio de Trasplantes, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano Seguro Social, Ciudad de México, México.
| | | | | | | | | | | | | |
Collapse
|
15
|
Benzar IM. [CYSTIC LYMPHATIC MALFORMATIONS IN CHILDREN: CLINICAL SIGNS AND CHOICE OF THE TREATMENT TACTIC]. Klin Khir 2016:37-39. [PMID: 30272867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In the investigation 97 children were included, suffering cystic lymphatic malformations, who were treated in 2011 — 2016 yrs. Lymphatic malformations were classified, depending on the cysts size: macrocystic, microcystic, and the mixed. Sclerotherapy, using biological preparation ОК—432, was conducted in 80 (82.5%) children, surgical excision of lymphatic malformations — in 10 (10.3%), the combined treatment — in 7 (7.2%).
Collapse
|
16
|
El-Tahan MR, Doyle DJ, Khidr AM, Regal MA, El Morsy AB, El Mahdy M. Awake tracheal intubation with combined use of King Vision™ videolaryngoscope and a fiberoptic bronchoscope in a patient with giant lymphocele. Middle East J Anaesthesiol 2014; 22:609-612. [PMID: 25669006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
17
|
Kumar A, Ramakrishnan TS, Sahu S. Primary cervical thoracic duct cyst: a case report and review of the literature. Ear Nose Throat J 2014; 93:E17-21. [PMID: 25025416 DOI: pmid/25025416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Thoracic duct cysts are uncommon entities that are usually found in the thoracic segments of the thoracic duct. The presence of a thoracic duct cyst in the cervical area has been rarely reported. Etiologically, these cysts can arise either as a primary growth or secondary to trauma, obstruction, or inflammation. This entity was first described in 1964, and only 33 cases have been previously reported in literature. Of these, 16 cases involved a primary cyst. We report a new case of a primary thoracic duct cyst, and we discuss its presentation, diagnosis, and management, with an emphasis on meticulous surgical technique. We also review the relevant literature.
Collapse
Affiliation(s)
- Ameet Kumar
- Department of Gastrointestinal Surgery, Surgical Division, Base Hospital, New Delhi, India 110010.
| | | | | |
Collapse
|
18
|
Sasaki S, Sueyoshi N, Yamaoka Y, Yano Y, Hiroyoshi Y, Yoshinaka H, Anami T, Watanabe A, Sugahara A, Mukai H, Wakahara T, Toyokawa A, Teramura K. [Case with gradually enlarging lymphoepithelial cyst of the pancreas that necessitated enucleation]. Nihon Shokakibyo Gakkai Zasshi 2014; 111:326-333. [PMID: 24500323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 54-year-old man exhibited a pancreatic mass on abdominal ultrasonography. Diagnostic imaging with endoscopic ultrasonography, computed tomography, and magnetic resonance imaging revealed that the mass comprised various internal structures and was not connected to the pancreatic duct. Over a period of 4 years and 2 months, the mass increased from 22mm to 32mm in diameter. Laparoscopic enucleation was performed, and a histopathological diagnosis of a lymphoepithelial cyst (LEC) of the pancreas was obtained. LEC is rare and seldom reported in the literature. Although it is considered to be benign, most case reports indicate that they tend to increase in size. This indicates that LEC should be carefully monitored if surgery is not performed after diagnosis.
Collapse
Affiliation(s)
- Sho Sasaki
- Department of Gastroenterology, Yodogawa Christian Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Kryzhanivs'ka AI. [Complications of surgical stage of treatment in patients with cancer of cervix uteri stage IIB]. Klin Khir 2013:75-78. [PMID: 24501997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The results of treatment of 127 patients, suffering cervix uteri cancer stage IIB in period of 1998 - 2012 yrs, were analyzed. Complications of surgical stage of the combined treatment have had occurred in 40.9% patients, including 40.5% patients, to whom neoadjuvant chemotherapy was conducted and in 41.5%--radiation therapy (RTH). The main postoperative complications--retroperitoneal lymphatic cysts--were revealed in 35.4% patients. The factors, raising the risk of postoperative complications occurrence, are following: the primary tumor spreading, metastatic affection of lymphatic nodes of pelvic cavity, preoperative conduction of RTH or chemotherapy.
Collapse
|
20
|
Nowak K, Bönninghoff R, Geiger M, Post S, Schnülle P, Schwarzbach M. Compression stockings limit the incidence of postoperative lymphocele in kidney transplantation. In Vivo 2013; 27:561-564. [PMID: 23812232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Lymphoceles account for considerable morbidity rates after kidney transplantation. As yet, there is no therapeutic strategy to prevent the formation of lymphoceles. The lower limb provides a large reservoir for lymphatic tissue. Prophylactic compression therapy limits tissue volume and edema formation and may therefore reduce postoperative lymph flow. PATIENTS AND METHODS AND RESULTS In a non-randomized prospective study using a historical control group prior to 2006 as comparison from our center (2004-2008: total n=126), we found that lymphoceles are significantly diminished on the ipsilateral lower limb of the operative side when patients wear class II compression stockings (n=69) for four weeks after transplantation compared to patients achieving standard antithrombotic therapy by compression class I stockings (n=57) for thrombosis prophylaxis until full mobilization (33% versus 15%, p-value<0.05). Furthermore, a significantly lower percentage of patients needed surgical treatment of the lymphoceles for obstructive complications after class II compression (4% versus 18%, p-value<0.01). These findings were independent of the recipients' demographics, the duration of the surgical procedure, and the operating surgeon. CONCLUSION Further studies are needed to demonstrate the usefulness of compressing stockings for the reduction of lymphoceles after kidney transplantation. This approach would not only reduce post-transplantation morbidity, but also provide an easy and cost-effective treatment without side-effects.
Collapse
Affiliation(s)
- Kai Nowak
- Department of Surgery, Mannheim University Medical Center, Heidelberg University, Mannheim, Germany.
| | | | | | | | | | | |
Collapse
|
21
|
Naik R. Commentary on 'Laparoscopic lymphocele fenestration in gynaecological cancer patients after retroperitoneal lymph node dissection as a first-line treatment option'. BJOG 2013; 120:636. [PMID: 23599964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Raj Naik
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK.
| |
Collapse
|
22
|
Shamsa A, Asadpour AA, Oraee F. Post-cadaveric kidney transplant lymphocele which did not respond to percutaneous drainage. Saudi J Kidney Dis Transpl 2012; 23:585-587. [PMID: 22569451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
|
23
|
Reiffel AJ, Henderson PW, Karwowski JK, Spector JA. An interdisciplinary approach to the prevention and treatment of groin wound complications after lower extremity revascularization. Ann Vasc Surg 2011; 26:365-72. [PMID: 22055159 DOI: 10.1016/j.avsg.2011.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 07/04/2011] [Accepted: 08/08/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND If not effectively treated, groin wound infections following lower extremity revascularization (LER) may result in graft or limb loss. METHODS A retrospective review was performed of all patients who underwent muscle flap transposition by a single surgeon after LER between 2006 and 2010. RESULTS Twenty-nine muscle transposition flaps were performed in 24 patients (21 sartorius, 6 rectus femoris, and 2 gracilis). Nineteen were for treatment of groin wound infections, two for treatment of lymphocele, one for coverage of exposed graft in the setting of pyoderma gangrenosum, and seven for infection prophylaxis. Two graft losses followed flap placement. The limb loss rate was 4%. When performed for therapeutic purposes, graft salvage rates were 100% for autogenous and 92% for synthetic grafts. CONCLUSIONS Muscle transposition flaps are an effective means of graft salvage in the setting of groin wound complications following LER and should be considered for infection prophylaxis in high-risk patients.
Collapse
Affiliation(s)
- Alyssa J Reiffel
- Division of Plastic Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | | | | | | |
Collapse
|
24
|
Khoder WY, Becker AJ, Seitz M, Haseke N, Schlenker B, Stief CG. Modified laparoscopic lymphocele marsupialization for the treatment of lymphoceles after radical prostatectomy: first results. J Laparoendosc Adv Surg Tech A 2011; 21:145-8. [PMID: 21375423 DOI: 10.1089/lap.2010.0327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to describe a simple modification of the laparoscopic pelvic lymphocele marsupialization (LL) following radical prostatectomy lymphoceles (RP-LC). PATIENTS AND METHODS Forty-eight patients (57-76 years) with symptomatic RP-LC underwent surgery in our institute. This was through an open approach in 6 (open drainage [OL]) and LL in rest of the patients (12 with 3 [LL3] and 30 with 2 [LL2] trocars). All except 2 patients were refractory to percutaneous tube drainage and/or sclerotherapy. Pelvic ultrasound and/or computed tomography scans revealed LC size (4 × 5-11 × 12 cm) and volumes (100-1100 mL). RESULTS All surgeries were uneventful with an operative time of 15-60 minutes for LL and 35-90 minutes for OL and it became shorter with increasing experience with LL2 (15-25 minutes). Mean hospitalization time was 2.3 and 8 days after LL (LL2 and LL3) and OL, respectively. LC were at the right side in 10 patients, at the left side in 6, and at both sides in 14. Postoperative ultrasound revealed primary success in all cases. No patient developed recurrence of or had treatment for lymphocele during a mean follow-up time of 19 months. CONCLUSION LL2 is a simple, feasible, and safe procedure that could be used as a first-line treatment for large, noninfected symptomatic or refractive RP-LC.
Collapse
Affiliation(s)
- Wael Y Khoder
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
25
|
Skreptsova NS, Novikova EG, Stepanov SO. [On ultrasound follow-up of patients after pelvic lymphadenectomy]. Vopr Onkol 2011; 57:327-336. [PMID: 21882604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ultrasound examination of the peritoneal cavity, small pelvis, iliac lymph nodes and femoral blood vessels (downstream of the blood flow) was performed in 346 patients who had undergone pelvic lymphadenectomy. Post-operative lymphocele developed in 302 (7.2%). However, treatment was required in 98 (28.3%) only. Our strategy of follow-up after pelvic lymphadenectomy facilitated diagnosis and effective excision of lymphocele without resorting to laparotomy due to an improved procedure of ultrasound monitoring.
Collapse
|
26
|
Kumar VV, Sharma N. Parotid lymphoepithelial cysts as an indicator of HIV infection. J Can Dent Assoc 2011; 77:b28. [PMID: 21385534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Vinay V Kumar
- Swami Devi Dyal Hospital and Dental College, Barwala, Haryana, India.
| | | |
Collapse
|
27
|
Abstract
Lymphoceles represent a common complication following pelvic lymphadenectomy and radical retropubic prostatectomy. Relevant articles published in the last 25 years and our own results based on a prospective study were taken as the basis for a treatment algorithm for lymphoceles after radical prostatectomy.The type of intervention depends on the clinical situation of the patient. Symptomatic lymphoceles can be managed initially by percutaneous aspiration with or without instillation of sclerosing agents. However, lymphocele recurrence rates are high. Symptomatic, sterile lymphoceles appear to be ideally suited for drainage by laparoscopic techniques. This method is effective, usually immediately definitive, results in minimal patient morbidity, and allows for a more rapid recovery. Infected lymphoceles require percutaneous or open surgical drainage. Laparoscopic marsupialization of symptomatic lymphoceles after pelvic lymphadenectomy for prostate cancer appears to be safe and effective. Because of the minimal postoperative morbidity, rapid convalescence, and low recurrence rate, laparoscopic lymphadenectomy should be considered as a first-line treatment for symptomatic, uninfected sterile lymphoceles.
Collapse
Affiliation(s)
- P Anheuser
- Zertifiziertes Prostatakarzinomzentrum, Klinik für Urologie und Kinderurologie, St.-Antonius-Hospital Eschweiler, Dechant-Deckers-Strasse 8, Eschweiler, Germany.
| | | | | | | | | |
Collapse
|
28
|
Friedersdorff F, Roller C, Baumunk D, Giessing M, Miller K, Weikert S, Fuller TF. [Incarcerated hernia after laparoscopic drainage of a lymphocele]. Urologe A 2010; 49:1169-71. [PMID: 20464365 DOI: 10.1007/s00120-010-2323-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Laparoscopic lymphocele drainage is considered the gold standard for the treatment of lymphoceles after kidney transplantation. We report on a female patient who developed a symptomatic posttransplant lymphocele. After laparoscopic lymphocele drainage the patient presented with acute pain in the left lower abdomen. A CT scan showed a hernia into the peritoneal window. This is a rare but potentially severe complication after intraperitoneal lymphocele drainage. CT imaging and swift reoperation with enlargement of the peritoneal window are critical to avoid serious complications. To avoid bowel incarceration, the peritoneal window should be as large as possible.
Collapse
Affiliation(s)
- F Friedersdorff
- Klinik für Urologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | | | | | | | | | | | | |
Collapse
|
29
|
Chinkova N, Strateva D, Tancheva L, Tsvetkov C, Gorchev G. [Case report of infected lymphocele]. Akush Ginekol (Sofiia) 2010; 49:64-67. [PMID: 20734644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The lymphorrhea is a problem that we face in the early postoperative period in patients undergoing lymph node dissection (LND) for treatment of cervical cancer (CC). The formation of lymphocele most often in the pelvis is as a consequence. The incidence of lymphocele different, ranging from 0.4% to 58.7%. It is diagnosed most common in random checks in the asymptomatic or by presence of complains in symptoms. Ultrasound is most commonly applied together with computed axial tomography. One of the methods for treatment of symptomatic lymphocele is percutaneous drainage under ultrasonic control. As a complication of this procedure are observed cases of infection of lymphocele.
Collapse
|
30
|
Sathyajith KA, Umesh G, Shwethapriya R, Amitha RA. Beware of external tracheal compression in children with acute onset stridor. Paediatr Anaesth 2009; 19:542-4. [PMID: 19453588 DOI: 10.1111/j.1460-9592.2009.02981.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Buts S, Fillet M, Bonnet P. [About the discovery of a hepatic subcapsular collection as early complication of transperitoneal laparoscopy. Review of the clinical implications based on the hepatic capsular and retroperitoneal anatomy, its subdivisions and communications]. Rev Med Liege 2008; 63:729-732. [PMID: 19180832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a case of hepatic subcapsular collection as early complication of transperitoneal laparoscopy. The etiology seems to be a detachment of the hepatic capsule induced by laparoscopic gas. We discuss the anatomic data about the liver capsule, renal fascia and retroperitoneal subdivisions supporting such a mechanism.
Collapse
|
32
|
Khalil PN, Ladurner R, Mussack T, Hallfeldt K. [Traumatic lymphocele after yoga exercise]. MMW Fortschr Med 2008; 150:39. [PMID: 18700411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- P N Khalil
- Abteilung für Allgemein- und Viszeralchirurgie, Klinikum Innenstadt der LMU München.
| | | | | | | |
Collapse
|
33
|
Khwaja HA, Chaudhry SM. Mediastinal lymphocele following radical esophagogastrectomy. Can J Surg 2008; 51:E48-E49. [PMID: 18377744 PMCID: PMC2386322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- Haris A Khwaja
- Department of Surgery, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex, London, UK.
| | | |
Collapse
|
34
|
Homberg R, Kollias A. [Laparoscopy of lymphocele using window technique]. Aktuelle Urol 2008; 39:14-16. [PMID: 18300401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- R Homberg
- Klinik für Urologie und Kinderurologie, Ammerlandklinik, Westerstede
| | | |
Collapse
|
35
|
Saxena AK, Haxihja E, Kleinlein B, Höllwarth ME. Lymphoceles in premature infants after congenital diaphragmatic hernia repair: Thoracoscopic management. J Thorac Cardiovasc Surg 2007; 133:584-5. [PMID: 17258613 DOI: 10.1016/j.jtcvs.2006.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 09/25/2006] [Indexed: 11/19/2022]
Affiliation(s)
- Amulya K Saxena
- Department of Pediatric Surgery, Medical University of Graz, Graz, Austria.
| | | | | | | |
Collapse
|
36
|
Abstract
Traumatic lymphoceles are usually the result of surgical injuries or blunt trauma. Although usually described in the pelvis after radical pelvic node dissection or kidney transplantation, traumatic lymphoceles are rare. Diagnosis is based on CT scan and confirmed by fine needle aspiration with biochemical analysis. Treatment modalities are not standardized and different techniques have been described. We report herein a case of anterior thoracic wall lymphocele due to blunt trauma treated in our department.
Collapse
Affiliation(s)
- K Ballas
- Department of Surgery, Aristotele University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Greece
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
BACKGROUND AND PURPOSE Clinically significant post-transplantation lymphoceles are not uncommon. Surgical marsupialization with internal peritoneal drainage is the treatment of choice. We describe the successful laparoscopic formation of a peritoneal window for post-transplantation lymphocele drainage as an effective and minimally invasive procedure. PATIENTS AND METHODS Between August 1995 and September 2001, 135 consecutive renal transplantations were performed, and 9 patients developed clinically significant lymphoceles. Four of the nine patients were treated by laparoscopic drainage via a peritoneal window. Analysis of predisposing risk factors commonly associated with lymphoceles was performed. The surgical outcome was assessed. RESULTS Laparoscopic drainage was successful in all patients. The average operative time was 40 minutes. The mean hospital stay was 1.5 days for patients undergoing laparoscopic drainage versus 5 days for those having open surgical drainage. Accidental division of the right native ureter occurred in one patient, which was identified intraoperatively. None of the patients had developed recurrence of lymphocele after a mean follow-up of 10.7 months (range 6-22) months. CONCLUSION In patients with a clinically significant post-transplantation lymphocele of appropriate size and location, laparoscopic drainage is easy, safe, and effective. It decreases hospital stay and hastens convalescence.
Collapse
|
38
|
Taweemonkongsap T, Srinualnad S, Nualyong C, Tantiwong A, Soontrapa S. Novel Technique to Prevent Lymphocele Recurrence after Laparoscopic Lymphocele Fenestration in Renal Transplant Patients. J Endourol 2006; 20:654-8. [PMID: 16999619 DOI: 10.1089/end.2006.20.654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To describe the use of nonabsorbable polymer ligating (NPL) clips to prevent recurrence after laparoscopic lymphocele fenestration and to determine the efficacy and safety of this treatment in renal-transplant patients at our center. PATIENTS AND METHODS From December 2000 to October 2005, nine patients with a mean age of 38.5 years (range 26-54 years) and symptomatic lymphoceles were treated laparoscopically among 144 renal-transplant patients. The overall incidence of symptomatic lymphocele was 6.2% (9/144). The mean time from transplantation to diagnosis was 55.5 days (range 20-98 days). Patient and lymphocele characteristics, complications, recurrence rate, and outcomes of this procedure were analyzed retrospectively. RESULTS Laparoscopic treatment was successful in eight patients; the other was converted to open surgery. One patient sustained an allograft-ureteral injury. The mean operative time was 90.7 minutes (range 75-120 minutes), and the mean postoperative stay was 4.1 days (range 1-7 days). Lymphocele recurrence was found in the first two patients after laparoscopic surgery without NPL clips. With a mean follow-up of 42.3 months (range 31-51 months), no recurrence was observed in patients in whom NPL clips were used to maintain the patency of the peritoneal window. No late laparoscopy-related complications occurred. CONCLUSION Laparoscopic lymphocele fenestration with NPL clips is a safe, technically easy, and efficacious procedure for the treatment of symptomatic lymphoceles after renal transplantion.
Collapse
Affiliation(s)
- Tawatchai Taweemonkongsap
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | | | | | | |
Collapse
|
39
|
Abstract
In a 32-year-old pregnant woman, routine ultrasonography revealed right hydronephrosis and a huge retroperitoneal mass (20 x 7 cm) containing a fluid collection. Percutaneous drainage of the mass was performed and 2 L of clear, yellowish fluid was collected. Four months following the delivery, a recurrent retroperitoneal lymphocele was identified. Six months after the delivery, laparoscopic marsupialization was performed through a 10-mm umbilical camera port and two 5-mm ports on the right side of the abdomen. A posterior peritoneal window was established by creating a wide opening in the anterior wall of the lymphocele. Subsequent ultrasonography did not indicate a recurrence of the lymphocele or right hydronephrosis over a follow-up period of 8 months.
Collapse
Affiliation(s)
- Tetsuhiro Ikeda
- Department of Urology, Ehime University School of Medicine, Toon city, Ehime, Japan.
| | | | | | | | | | | |
Collapse
|
40
|
Kolsi M, Daoud S, Abdelmalek M, Masmoudi A, Kammoun S, Frikha I. [Mediastinal localisation of a thoracic duct lymphocele--account of a surgical case]. Rev Mal Respir 2006; 22:1039-42. [PMID: 16598864 DOI: 10.1016/s0761-8425(05)85735-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lymphocele of the thoracic duct is a rare pathological entity occurring as a consequence of deterioration and cystic dilation wall of this vessel. It may be of congenital or degenerative origin. OBSERVATION We report the case of a 47 year old patient, operated on for a symptomatic cyst localised by CT scan to the inferoposterior mediastinum. At postero-lateral thoracotomy it was identified as a lymphocele and completely resected. Chemical analysis of the liquid and histopathology study of the cystic wall confirmed the diagnosis. The patient's post operative course was uneventful. CONCLUSION This case demonstrates the clinical characteristics of this entity and describes diagnostic techniques and surgical management.
Collapse
Affiliation(s)
- M Kolsi
- Service de Chirurgie Thoracique et Cardiovasculaire EPS Habib Bourguiba Sfax, Tunisie.
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
Lymphocele incidence after kidney transplantation is as high as 18%. We retrospectively studied the therapy of 42 lymphoceles that occurred in our clinic between 1990 and 2005, focusing on possible predisposing factors for their formation and the results of several therapy variants: conservative, operative, percutaneous puncture, and laparoscopic or open marsupialization. There was no connection between lymphocele formation and the following parameters: the extent to which the iliac vessels had been prepared, the materials used for the preparation, or whether clips or ligatures were applied. Lymphoceles may originate either from the lymphatic system of the recipient or the transplanted kidney. The most sensible measures to prevent their occurrence therefore seems to be to restrict the transplant bed to the smallest permissible level with careful ligature of the lymphatic vessels in the area of the kidney hilus. Treatment for lymphoceles should start with minimally invasive measures. We use the following algorithm in our clinic: puncture to differentiate between urinoma/lymphocele and to test for bacterial infection, sclerotization (200 mg doxycyclin), and finally marsupialization if persistent. The choice of operative technique depends on the location. This algorithm resulted in a relapse rate of 9.5% during the postoperative observation period of up to 15 years.
Collapse
Affiliation(s)
- A Hamza
- Department of Urology and Transplant Center of the Martin Luther University, Halle-Wittenberg, Halle, Germany
| | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
BACKGROUND Primary (spontaneous) cervical lymphoceles in adults are extremely rare. More frequently occurring acquired cervical lymphoceles have been described in the setting of a neck trauma or after a neck dissection. We report a case of a spontaneous left cervical lymphocele in a previously asymptomatic female. METHODS AND RESULTS A 44-year-old woman presented with a 2-month history of a left neck mass initially noted by her physician during a routine physical examination. She denied prior head and neck surgery or neck trauma. CT scan of the neck revealed a left cystic mass. Fine-needle aspiration of the cyst yielded chylous material and lymphocytes. The surgical specimen grossly and microscopically was consistent with a lymphocele. The diagnosis was confirmed using D2-40 antibody targeting lymphatic endothelial cells lining the cyst. CONCLUSION Primary cervical lymphocele should be included in the differential diagnosis of a solitary neck mass in an adult.
Collapse
Affiliation(s)
- Adrianna Hekiert
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA
| | | | | | | |
Collapse
|
43
|
Uchinami M, Morioka K, Doi K, Nakamura T, Yoshida M, Tanaka K. Retroperitoneal laparoscopic management of a lymphocele after abdominal aortic surgery: A case report. J Vasc Surg 2005; 42:552-5. [PMID: 16171605 DOI: 10.1016/j.jvs.2005.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Accepted: 04/13/2005] [Indexed: 11/28/2022]
Abstract
A retroperitoneal lymphocele is a rare complication of abdominal aortic surgery. We present a case of 77-year-old man who developed a retroperitoneal lymphocele 14 days after undergoing graft replacement for an abdominal aortic aneurysm. Paracentesis showed a white and turbid fluid that was determined to be chyle. Conservative therapy, including percutaneous drainage, fasting, and total parenteral nutrition, was unsuccessful. Retroperitoneal laparoscopic ligation of the leaking lymphatics was performed on postoperative day 33. The postoperative course was satisfactory. The laparoscopic approach to retroperitoneal lymphocele treatment after abdominal aortic repair is a safe and minimally invasive therapeutic method.
Collapse
Affiliation(s)
- Masaru Uchinami
- Second Department of Surgery, Faculty of Medical Sciences, University of Fukui, Japan.
| | | | | | | | | | | |
Collapse
|
44
|
Carrafiello G, Laganà D, Mangini M, Cuffari S, Cafaro T, Recaldini C, Genovese E, Fugazzola C. The role of interventional radiology in the management of kidney transplant complications. Radiol Med 2005; 110:249-61. [PMID: 16200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE To evaluate the role and the effectiveness of interventional radiology in the treatment of renal transplant complications. MATERIALS AND METHODS From 1996 to 2004 a total of 288 kidney transplants from cadavers were performed in our Institute. The kidney was always collocated in iliac fossa by creating a vascular anastomosis with the external iliac artery and vein; in all cases the ureter was implanted into the recipient bladder. During the follow-up, 34 complications were observed. Twenty-seven complications in 25 patients (20 males and 5 females; age 35-65 years) were treated by a radiologic procedure: 9 renal artery stenosis and 1 native external iliac artery stenosis (by PTA), 5 ureteral obstructions (by nephrostomy and ureteral stenting), 8 ureteral leaks (by nephrostomy, in 2 cases associated to ureteral stenting) and 4 limphoceles (by percutaneous ultrasound-guided catheter drainage). RESULTS Primary technical success was obtained in 20/27 cases (74%). Success was obtained with a second interventional procedure in 3/27 cases, 2 limphoceles and 1 ureteral fistula (secondary technical success: 85.2%), with a clinical final success in 23/27 cases (85.2%). We observed a peri-procedural complication rate of 3.7% (1 renal artery post-PTA dissection during a restenosis treatment). Four cases (1 renal arterial post-PTA dissection, 1 ureteral obstruction, 1 ureteral leak and 1 limphocele) needed a surgical correction (14.8%). CONCLUSIONS Interventional radiology is the first therapeutic approach to treat renal transplant complications. It shows good technical and clinical results and a low complication rate. Surgery had to be considered only if minimally invasive procedures are infeasible or ineffective.
Collapse
|
45
|
Abstract
The requirement for perioperative stress dose steroids (SDS) in patients on long-term steroid therapy is controversial, but SDS are given during perioperative care. Studies focusing on surrogate outcomes like cortisol levels indicate a possible requirement for SDS, but clinical results are sparse. We retrospectively compared outcomes of renal or pancreas/kidney transplant patients undergoing surgical lymphocele drainage who did (n=20) or did not (n=38) receive SDS. Patients had similar demographic characteristics (P=NS). No patient developed hypotension (SBP < 80 mmHg), mental status change, unexplained arthralgias, or ileus. Impaired wound healing occurred in one patient in each group (P=NS), and lymphocele recurrence occurred in 25% of the SDS group and 10.5% of the other group (P=.25). SBP decreased from baseline in both groups (P <.001) but did not differ between groups, and maximum blood glucose was higher in the SDS group (P=.04). No difference was observed in other measured parameters. These data indicate that SDS increased the risk of hyperglycemia and provided no apparent benefit. A prospective study is warranted to confirm these findings.
Collapse
Affiliation(s)
- A S Mathis
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Livingston, NJ 07039-56720, USA.
| | | | | |
Collapse
|
46
|
Schips L, Lipsky K, Hebel P, Hutterer G, Gidaro S, Petritsch PH, Zigeuner RE. Laparoscopic fenestration of lymphoceles after kidney transplantation with diaphanoscopic guidance. Urology 2005; 66:185-7. [PMID: 15992897 DOI: 10.1016/j.urology.2005.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Revised: 01/31/2005] [Accepted: 02/18/2005] [Indexed: 10/25/2022]
Abstract
In laparoscopic fenestration of lymphoceles after kidney transplantation, identification of the correct site of incision is sometimes difficult. We developed a new technique, using diaphanoscopy in 3 patients. After ultrasound-guided puncture and dilation, the correct incision site is identified by white light with a cystoscope inserted into the lymphocele cavity.
Collapse
Affiliation(s)
- Luigi Schips
- Department of Urology, University Hospital, Medical University of Graz, Graz, Austria.
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Laparoscopic marsupialization of lymphocele carries 13% recurrence rate, 6% injury to other organs, 12% omentoplasty, 6% open conversion and 1.8 average hospital days. A novel, simplified technique of intraperitoneal catheter drainage of lymphocele is described. Under ultrasound guidance and using the Seldinger technique, a 13F Hickman catheter was introduced into the lymphocele and connected subcutaneously to a small peritoneal window performed 5 cm apart. During the last 8 years the procedure was performed under local anesthesia in 14 patients on an outpatient basis with success (e.g. resolution of both hydronephrosis and lymphocele). One wound infection required removal of the catheter without recurrence. In another patient laparoscopy showed retraction of the catheter under the peritoneum as cause for lymphocele recurrence. In all cases absence of injury to the GU tract was confirmed by absence of extravasation of indigo carmine given intravenously. Intraperitoneal catheter drainage of post-transplant lymphocele is an effective outpatient procedure. It avoids the drawbacks of general anesthesia required by open and laparoscopic marsupialization procedures and deserves to be evaluated in a multicenter study.
Collapse
Affiliation(s)
- Dai D Nghiem
- Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
| | | |
Collapse
|
48
|
Abstract
BACKGROUND The authors undertook a retrospective study to define the incidence of groin wound lymphatic complications at their institution and to review their experience with treatment of the complications. METHODS Operating room records and patient databases of the two primary vascular surgeons at an academic teaching institution were reviewed retrospectively. Groin lymphatic complications were diagnosed by clinical presentation and confirmed with noninvasive imaging. Surgical management included percutaneous methods, ligation of leaking lymphatics, excision, and/or muscle flap coverage. RESULTS From June of 1989 to June of 2002, 538 patients had arterial revascularization procedures involving the groin. Twenty-seven patients with groin wound lymphatic complications were identified; seven of them had bilateral complications, for a total of 34 complication sites. Common comorbidities included hypertension, coronary artery disease, chronic renal insufficiency, and tobacco use. The majority (85 percent) had artificial material in the bypass graft, and 10 patients had undergone a previous operation at the same site. The mean time to identification of groin lymphatic complications after vascular surgery was 14 days. Common presentations included swelling (n = 16), drainage (n = 13), erythema (n = 4), and leg edema (n = 1). At presentation, 17 patients (63 percent) were receiving antibiotics and 21 (78 percent) were receiving anticoagulation or antiplatelet therapy. Of the 34 complication sites, 12 were managed with drainage or excision and 22 with muscle flap surgery, 10 of which failed less aggressive therapy. Muscle flaps included the gracilis (n = 19), sartorius (n = 1), rectus abdominis (n = 1), and rectus femoris muscles (n = 1). Operative cultures were positive in 23 of the 34 groin lymphatic complication sites. A biopsy specimen of a healed gracilis flap obtained at 1 year demonstrated notable lymphatic channels, possibly supporting theories that rotated muscle becomes a lymphatic conduit. CONCLUSIONS The authors found that muscle flap surgery provides single-intervention therapy for successful resolution of lymphoceles, with a low complication rate and fairly rapid recovery in a high-risk patient population. Flaps also salvage cases that have failed conservative therapy and provide hardy coverage for a wound bed that is often infected.
Collapse
Affiliation(s)
- Michele A Shermak
- Division of Plastic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | | | | | | | | |
Collapse
|
49
|
Tanaka K, Ohmori Y, Mohri Y, Tonouchi H, Suematsu M, Taguchi Y, Adachi Y, Kusunoki M. Successful treatment of refractory hepatic lymphorrhea after gastrectomy for early gastric cancer, using surgical ligation and subsequent OK-432 (Picibanil) sclerotherapy. Gastric Cancer 2005; 7:117-21. [PMID: 15224199 DOI: 10.1007/s10120-004-0276-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2003] [Accepted: 02/16/2004] [Indexed: 02/07/2023]
Abstract
Postoperative hepatic lymphorrhea is a very rare complication after abdominal surgery. Hepatic lymphorrhea, not containing chyle, involves an internal lymph fistula between the lymphatic channels toward the cisterna chyli and the peritoneal cavity. Over the past 20 years, 17 cases have been reported in Japan. Here, we report a further case, of a patient with successfully treated intractable hepatic lymphorrhea following gastrectomy for early gastric cancer. We review 18 cases, including the present case, with respect to the management of postoperative lymphorrhea refractory to conventional medical treatment.
Collapse
Affiliation(s)
- Kouji Tanaka
- The Second Department of Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
BACKGROUND/PURPOSE Lymphoceles are frequently observed as a surgical complication after renal transplantation. Whereas the frequency, pathogenesis, diagnosis, and treatment of lymphoceles has been well described in adult patients, no data are available for the pediatric age group. METHODS Since December 2000; 5 children (2 boys and 3 girls; median age, 6 years; range, 6 to 15 years) of a total of 21 (10 boys and 11 girls; median age, 13 years; range, 2 to 19 years) children undergoing kidney transplantation had a posttransplant lymphocele. The clinical course, renal function, and ultrasonographic appearance of the transplanted kidney of all children were observed in a prospective manner. RESULTS The lymphoceles became obvious between day 13 and 48 (median, 20 days) posttransplantation. Lymphocele size ranged from 2.0 x 3.0 cm to 11.0 x 15.0 cm. They were localized at any site (superior, inferior, lateral, medial, and dorsal) around the transplanted kidney. Four patients had a significant decrease of renal function, in 2 children mild urinary tract obstruction occurred, and 1 patient suffered from considerable abdominal pain. Diagnosis was established by ultrasound scan in all cases. All patients were treated by laparoscopic fenestration of the lymphocele immediately after diagnosis, except 1 patient, in whom fenestration was not done until 10 months later. Operating time ranged from 45 to 90 minutes (median, 62 minutes). No intraoperative or postoperative complication occurred. Renal function, urinary tract obstruction, and pain recovered soon after operation in all patients. After 3 to 10 months (median, 8 months) postoperatively, no relapse has been observed. CONCLUSIONS Our data emphasize laparoscopic fenestration as the treatment of choice for children with posttransplant lymphoceles, because it is safe, effective, and technically easy to perform. If done early after diagnosis, renal function will recover immediately.
Collapse
|