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Pieper CC. Back to the Future II-A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions. Invest Radiol 2023; 58:610-640. [PMID: 37058335 DOI: 10.1097/rli.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
ABSTRACT Lymphatic imaging and interventional therapies of disorders affecting the lymphatic vascular system have evolved rapidly in recent years. Although x-ray lymphangiography had been all but replaced by the advent of cross-sectional imaging and the scientific focus shifted to lymph node imaging (eg, for detection of metastatic disease), interest in lymph vessel imaging was rekindled by the introduction of lymphatic interventional treatments in the late 1990s. Although x-ray lymphangiography is still the mainstay imaging technique to guide interventional procedures, several other, often less invasive, techniques have been developed more recently to evaluate the lymphatic vascular system and associated pathologies. Especially the introduction of magnetic resonance, and even more recently computed tomography, lymphangiography with water-soluble iodinated contrast agent has furthered our understanding of complex pathophysiological backgrounds of lymphatic diseases. This has led to an improvement of treatment approaches, especially of nontraumatic disorders caused by lymphatic flow abnormalities including plastic bronchitis, protein-losing enteropathy, and nontraumatic chylolymphatic leakages. The therapeutic armamentarium has also constantly grown and diversified in recent years with the introduction of more complex catheter-based and interstitial embolization techniques, lymph vessel stenting, lymphovenous anastomoses, as well as (targeted) medical treatment options. The aim of this article is to review the relevant spectrum of lymphatic disorders with currently available radiological imaging and interventional techniques, as well as the application of these methods in specific, individual clinical situations.
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Affiliation(s)
- Claus C Pieper
- From the Division for Minimally Invasive Lymphatic Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn; and Center for Rare Congenital Lymphatic Diseases, Center of Rare Diseases Bonn, Bonn, Germany
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Muacevic A, Adler JR, Niermeyer W, Joshi A. The Use of Ethanol Sclerotherapy To Treat a Large Cervical Lymphocele. Cureus 2022; 14:e33043. [PMID: 36721545 PMCID: PMC9881499 DOI: 10.7759/cureus.33043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Cervical lymphoceles are atypical lymphatic accumulations that develop within the subcutaneous tissue of the neck. While these accumulations have traditionally been removed via surgical excision, sclerotherapy has recently emerged as a reasonable option to prevent injury to surrounding vascular, neurologic, and pulmonary structures. The purpose of this case report is to describe the efficacy of ethanol sclerotherapy for a cervical lymphocele refractory to surgical embolization. We present the case of a 70-year-old male with a large cervical lymphocele that was initially treated with surgical embolization. The mass rapidly reaccumulated within two weeks and the patient subsequently underwent ethanol sclerotherapy with no evidence of re-accumulation after 18 months. This case highlights the utility of ethanol due to its better side-effect profile, widespread availability, and cheaper cost when compared to better-described agents.
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Les complications chirurgicales en urologie adulte : chirurgie de la vessie. Prog Urol 2022; 32:940-952. [DOI: 10.1016/j.purol.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022]
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Kashiwagi E, Ono Y, Yano H, Kosai S, Nagai K, Tanaka K, Higashihara H, Tomiyama N. Percutaneous sclerotherapy with OK-432 for lymphocele after pelvic or para-aortic lymphadenectomy: preliminary results. CVIR Endovasc 2022; 5:55. [PMID: 36264442 PMCID: PMC9584008 DOI: 10.1186/s42155-022-00332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Lymphoceles can result from disruption of lymphatic vessels after surgical procedures in areas with extensive lymphatic networks. Percutaneous catheter drainage with sclerotherapy can be performed for the treatment of lymphoceles. OK-432 has been used to treat benign cysts, such as lymphangioma and ranula. Therefore, we aimed to report the efficacy and safety of sclerotherapy using OK-432 for postoperative lymphoceles. This study retrospectively analyzed 16 patients who underwent sclerotherapy using OK-432 for postoperative pelvic and para-aortic lymphoceles between April 1, 2012, and March 31, 2020. All the patients underwent percutaneous drainage before sclerotherapy. The indications for sclerotherapy were persistent drainage tube output of greater than 50 mL per day and recurrent lymphoceles after percutaneous drainage. If less than 20 mL per day was drained after sclerotherapy, the tube was removed. When the drainage tube output did not decrease to less than 20 mL per day after the first sclerotherapy, the second sclerotherapy was performed 1 week later. Technical success was defined as the completion of drainage and sclerotherapy procedures. Clinical success was defined as the resolution of the patient's symptoms resulting from lymphoceles without surgical intervention. This study also evaluated the complications of sclerotherapy and their progress after sclerotherapy. RESULTS The mean initial lymphocele size and drainage duration after sclerotherapy were 616 mL and 7.1 days, respectively. The technical success rate and clinical success rate were 100% and 93%, respectively. Thirteen patients were treated by one-session sclerotherapy and three patients were treated by two-session sclerotherapy. Minor complications (fever) were observed in eight patients (50%). A major complication (small bowel fistula) was observed in one patient (7%). No recurrence of lymphoceles was observed during the mean follow-up period of 17 months. CONCLUSION Sclerotherapy with OK-432 is an effective therapeutic method for postoperative lymphoceles. Although most complications are minor, a small bowel fistula was observed in one patient.
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Affiliation(s)
- Eiji Kashiwagi
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yusuke Ono
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiroki Yano
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Shinya Kosai
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Keisuke Nagai
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Kaishu Tanaka
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiroki Higashihara
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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Microsurgical Lymphovenous Anastomosis for Pelvic Lymphoceles after Gynecological Cancer Surgery. J Plast Reconstr Aesthet Surg 2021; 75:1142-1149. [PMID: 34840117 DOI: 10.1016/j.bjps.2021.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/31/2021] [Accepted: 09/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pelvic lymphoceles are the most common complications after pelvic lymphadenectomy. Microsurgical procedures have attracted attention as an alternative treatment for lymphoceles. Here, we report six cases of refractory lymphoceles that were successfully treated using lymphovenous anastomosis (LVA). METHODS Six patients underwent surgery for gynecological cancers and developed pelvic lymphoceles, which did not respond to conventional treatment. We mainly performed LVA on the ipsilateral lower limbs, although some procedures were also performed on the contralateral limbs. The change in the lymphocele volume after LVA was examined using computed tomography and compared using the Wilcoxon test. RESULTS Five of the six refractory lymphocele cases were successfully treated using LVA, and the remaining case exhibited an 87% reduction in lymphocele volume. The average numbers of anastomoses were 6.7 on the ipsilateral side and 2.8 on the contralateral side (the median numbers: 6 [range: 5-9] vs. 3 [range: 1-4], P = 0.034). The average lymphocele volume decreased significantly from 414.0 mL preoperatively to 8.0 mL postoperatively (the median lymphocele volume: 255.8 [range: 61.5-1,329.2] vs. 0 [range: 0-47.7], P = 0.0313). CONCLUSION We found that microsurgical treatment was potentially effective for lymphoceles that did not respond to conventional treatment.
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Vacuum-Assisted Suction Drainage as a Successful Treatment Option for Postoperative Symptomatic Lymphoceles. ROFO-FORTSCHR RONTG 2021; 194:384-390. [PMID: 34649288 DOI: 10.1055/a-1586-3652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Lymphoceles often occur within several weeks or even months after surgery. Mostly asymptomatic and therefore undiagnosed, they may be self-healing without any treatment. A small percentage of postoperative lymphoceles are symptomatic with significant pain, infection, or compression of vital structures, thus requiring intervention. Many different treatment options are described in the literature, like drainage with or without sclerotherapy, embolization of lymph vessels, and surgical approaches with laparoscopy or laparotomy. Inspired by reports stating that postoperative suction drainage can prevent the formation of lymphoceles, we developed a simple protocol for vacuum-assisted drainage of symptomatic lymphoceles, which proved to be successful and which we would therefore like to present. MATERIALS AND METHOD Between 2008 and 2020, 35 patients with symptomatic postoperative lymphoceles were treated with vacuum-assisted suction drainage (in total 39 lymphoceles). The surgery that caused lymphocele formation had been performed between 8 and 572 days before. All lymphoceles were diagnosed based on biochemical and cytologic findings in aspirated fluid. The clinical and imaging data were collected and retrospectively analyzed. RESULTS In total, 43 suction drainage catheters were inserted under CT guidance. The technical success rate was 100 %. One patient died of severe preexisting pulmonary embolism, sepsis, and poor conditions (non-procedure-related death). In 94.8 % of symptomatic lymphoceles, healing and total disappearance could be achieved. 4 lymphoceles had a relapse or dislocation of the drainage catheter and needed a second drainage procedure. Two lymphoceles needed further surgery. The complication rate of the procedure was 4.6 % (2/43, minor complications). The median indwelling time of a suction drainage catheter was 8-9 days (range: 1-30 days). CONCLUSION The positive effects of negative pressure therapy in local wound therapy have been investigated for a long time. These positive effects also seem to have an impact on suction drainage of symptomatic lymphoceles with a high cure rate. KEY POINTS · Suction drainage of lymphoceles is an easy and successful method to cure symptomatic lymphoceles at various locations.. · We believe this to be due to the induction of cavity collapse and surface adherence.. · In most cases rapid clinical improvement could be obtained.. CITATION FORMAT · Franke M, Saager C, Kröger J et al. Vacuum-Assisted Suction Drainage as a Successful Treatment Option for Postoperative Symptomatic Lymphoceles. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1586-3652.
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Episalla NC, Orra S, Black CK, Dekker PK, Kim KG, Cardella JT, Evans KK. Sclerotherapy as an alternative treatment for complex, refractory seromas. J Surg Case Rep 2021; 2021:rjab224. [PMID: 34447570 PMCID: PMC8384448 DOI: 10.1093/jscr/rjab224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 11/15/2022] Open
Abstract
Traditional therapy for seromas often entails compression, aspiration, drainage, or surgical excision and re-closure; however, more complex, treatment-refractory seromas may require additional treatment. Sclerotherapy has been well documented in the treatment of simple pleural effusions, vascular malformations, lymphoceles and seromas. However, little evidence is available on the efficacy of sclerotherapy in complex, treatment-refractory seromas that develop post-operatively in patients with complex medical histories. We present a case series highlighting the use of sclerotherapy by interventional radiology as an alternative or adjunctive treatment method for chronic, high-volume post-operative seromas recalcitrant to multiple attempts of traditional treatment. At long-term follow-up, the seromas resolved after a maximum of four rounds of sclerotherapy with various combinations of known sclerosants. Highly complex cases of large, chronic seromas may be refractory to conservative modalities and re-closure. Sclerotherapy can be considered an alternative method or adjunctive treatment for chronic, recalcitrant post-operative seromas.
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Affiliation(s)
- Nicole C Episalla
- Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, DC 20007, USA
| | - Susan Orra
- Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, DC 20007, USA
| | - Cara K Black
- Department of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA 94304, USA
| | - Paige K Dekker
- Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, DC 20007, USA
| | - Kevin G Kim
- Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, DC 20007, USA
| | - John T Cardella
- Department of Interventional Radiology, Medstar Georgetown University Hospital, Washington, DC 20007, USA
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, DC 20007, USA
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Sommer CM, Pieper CC, Offensperger F, Pan F, Killguss HJ, Köninger J, Loos M, Hackert T, Wortmann M, Do TD, Maleux G, Richter GM, Kauczor HU, Kim J, Hur S. Radiological management of postoperative lymphorrhea. Langenbecks Arch Surg 2021; 406:945-969. [PMID: 33844077 DOI: 10.1007/s00423-021-02094-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated. METHOD A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term "lymphangiography." For the review, the inclusion criterion was "studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI)." Different exclusion criteria were defined (e.g., studies with <15 patients). The collected data comprised of clinical background and indications, procedural aspects and types of PLI, and outcomes. In the form of a pictorial essay, each author illustrated a clinical case with CL and/or PLI. RESULTS Seven studies (corresponding to evidence level 4 [Oxford Centre for Evidence-Based Medicine]) accounting for 196 patients were included in the synthesis and analysis of data. Preceding surgery resulting in postoperative lymphorrhea included different surgical procedures such as extended oncologic surgery or vascular surgery. Central (e.g., chylothorax) and peripheral (e.g., lymphocele) types of postoperative lymphorrhea with a drainage volume of 100-4000 ml/day underwent CL with subsequent PLI. The intervals between "preceding surgery and CL" and between "CL and PLI" were 2-330 days and 0-5 days, respectively. CL was performed before PLI to visualize the lymphatic pathology (e.g., leakage point or inflow lymph ducts), applying fluoroscopy, radiography, and/or computed tomography (CT). In total, seven different types of PLI were identified: (1) thoracic duct (or thoracic inflow lymph duct) embolization, (2) thoracic duct (or thoracic inflow lymph duct) maceration, (3) leakage point direct embolization, (4) inflow lymph node interstitial embolization, (5) inflow lymph duct (other than thoracic) embolization, (6) inflow lymph duct (other than thoracic) maceration, and (7) transvenous retrograde lymph duct embolization. CL-associated and PLI-associated technical success rates were 97-100% and 89-100%, respectively. The clinical success rate of CL and PLI was 73-95%. CL-associated and PLI-associated major complication rates were 0-3% and 0-5%, respectively. The combined CL- and PLI-associated 30-day mortality rate was 0%, and the overall mortality rate was 3% (corresponding to six patients). In the pictorial essay, the spectrum of CL and/or PLI was illustrated. CONCLUSION The radiological management of postoperative lymphorrhea is feasible, safe, and effective. Standardized radiological treatments embedded in an interdisciplinary concept are a step towards improving outcomes.
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Affiliation(s)
- C M Sommer
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany.
- Clinic of Radiology and Neuroradiology, Sana Kliniken Duisburg, Zu den Rehwiesen 9-11, 47055, Duisburg, Germany.
- Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany.
| | - C C Pieper
- Clinic of Diagnostic and Interventional Radiology, Bonn University Hospital, Venusberg-Campus 1, 53105, Bonn, Germany
| | - F Offensperger
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - F Pan
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - H J Killguss
- Clinic of General, Visceral, Thoracic and Transplantation Surgery, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - J Köninger
- Clinic of General, Visceral, Thoracic and Transplantation Surgery, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - M Loos
- Clinic of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - T Hackert
- Clinic of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - M Wortmann
- Clinic of Vascular and Endovascular Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - T D Do
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - G Maleux
- Department of Radiology, Leuven University Hospitals, Herestraat 49, 3000, Leuven, UZ, Belgium
| | - G M Richter
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - H U Kauczor
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - J Kim
- Department of Radiology, School of Medicine, Ajou University Hospital, Ajou University, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - S Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Ihwa-dong, Jongno-gu, Seoul, Republic of Korea
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Goßler C, Hillinger J, Burger M, Bründl J, Denzinger S, Gierth M, Breyer J. Epidemiology and therapy of symptomatic lymphoceles after robot-assisted radical prostatectomy (RARP). Transl Androl Urol 2021; 10:821-829. [PMID: 33718083 PMCID: PMC7947462 DOI: 10.21037/tau-20-1315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Lymphoceles are a common postoperative complication after radical prostatectomy with pelvic lymphadenectomy. Therapeutic options include cannulation and drainage (CD), drainage and instillation (DI), or laparoscopic fenestration (LF). The aim of this study was to investigate the epidemiology of symptomatic lymphoceles (SLC) and evaluate the treatment options. Methods We retrospectively analysed all patients who underwent robot-assisted radical prostatectomy (RARP) at our clinic from January 1, 2014 to December 31, 2018. All documented lymphoceles of these patients were recorded and analysed with regard to symptoms, possible infection and the treatment option (or options) chosen. Results We were able to include all 1,029 patients who underwent RARP in the aforementioned period of time. Of these, 18.1% were diagnosed with a lymphocele either when discharged or when readmitted and 6.9% experienced an SLC requiring treatment. Thirteen-point-seven percent of patients readmitted with SLC showed an accompanying thrombosis. Due to recurring or bilateral SLCs receiving different treatment options for each side, there was a total of 115 SLCs treated. CD was carried out in 102 cases. Twenty-point-six percent of patients were sufficiently treated this way, the rest required further treatment or experienced recurrences not requiring further treatment. DI was carried out in 56 cases. Of those patients, 46.4% were sufficiently treated. LF was carried out in 54 cases (either after CD, or after DI, or primarily). Of those patients, 98.1% were treated sufficiently. LF had a statistically significant higher success rate compared to CD and DI (P<0.001 respectively). Conclusions The study confirmed the significance of SLC as a common complication after RARP. LF turned out to be the most effective treatment option for SLC, while CD as well as DI have not been proven effective.
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Affiliation(s)
- Christopher Goßler
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Johannes Hillinger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Michael Gierth
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
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Comba C, Salik AE, Demirayak G, Erdogan SV, Sacan F, Ozdemir IA. Comparison of Postoperative Benign Pelvic Cysts Occurred after Gynecologic or Gyne-oncologic Surgery Treated with Percutaneous Transcatheteric Sclerosant Alcohol Therapy. Gynecol Minim Invasive Ther 2020; 9:198-203. [PMID: 33312862 PMCID: PMC7713659 DOI: 10.4103/gmit.gmit_107_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/16/2019] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives: Here, we compare the success of percutaneous transcatheter sclerosant alcohol therapy (PTSAT) for the postoperative treatment of benign pelvic cysts that occurred after gynecologic surgery. Materials and Methods: The study is a retrospective case–control trial. Gynecological patients who had symptoms due to postoperative pelvic cysts and received PTSAT after gynecologic surgery, between October 2008 and January 2018, were examined in a single training and research hospital in Turkey. Some factors were investigated for associations with postoperative pelvic cyst formation in patients who underwent gynecologic operations for malignancies or benign conditions. Statistical analysis used: The association between two independent and nonnormally distributed continuous variables was analyzed with the Mann–Whitney U-test. Spearman's rho correlation analysis was conducted to determine the correlation of two nonnormally distributed variables. Chi-square (or Fisher's exact test, when more suitable) was used to examine the correlation between categorical variables. Results: Statistically significant differences were found in terms of the average age was higher in patients with malignancies, and the average postoperative pelvic cyst detection time was higher in patients with benign pelvic cysts. While all patients were treated with PTSAT, repetitive PTSAT was required for seven benign and ten malign cases. Conclusion: Patients with pelvic cysts that occurred after gynecologic surgery for malignant conditions, large volume pelvic cysts and patients with benign cysts who underwent more than one surgery required recurrent PTSAT.
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Affiliation(s)
- Cihan Comba
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of Health Sciences, Sultangazi Haseki Training and Research Hospital, Istanbul, Turkey
| | - Aysun Erbahceci Salik
- Department of Interventional Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Demirayak
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sakir Volkan Erdogan
- Department of Gynecology and Obstetrics, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Filiz Sacan
- Department of Interventional Radiology, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Isa Aykut Ozdemir
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Medipol Mega University Hospital, Istanbul, Turkey
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Lim EJ, Aslim EJ, Lee FJ, Gan VHL. Intranodal lymphangio-embolisation as treatment for lymphocele after kidney transplantation: A case report. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820960189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction and objectives: The rate of symptomatic lymphoceles requiring intervention after renal transplantation is reported to be only 5.6%. Controversies prevail in the current literature regarding the management of symptomatic lymphoceles post renal transplantation, with no established algorithm. The creation of a peritoneal window, frequently performed laparoscopically, is deemed the gold standard for management. We herin report the case of a lymphocele post renal transplant treated minimally invasively with intranodal lymphangio-embolisation, with a review of the current literature of this uncommon procedure. Methods: This was a retrospective review of this patient’s electronic medical records. Results: We present a 43-year-old male with end-stage kidney disease secondary to chronic glomerulonephritis, having been on hemodialysis for seven years. He underwent a deceased donor dual kidney transplant, complicated postoperatively by renal vein thrombosis in one of the grafts, resulting in early graft nephrectomy as well as a distal ureterovesical leak requiring reimplantation. On re-implantation on postoperative day 16, he was noted to have a persistent high drain ouput with a normal drain fluid creatinine. A right intranodal lymphagiogram was performed, and this demonstrated an active lymph leak around the transplanted kidney. A 33% glue (N-butyl cyanoacrylate)-Lipodiol infusion was then injected at a rate of 0.2 mL/min intranodally under fluoroscopic guidance. The patient underwent another repeat embolisation five days later for a residual lymph leak with satisfactory results. Drain output subsequently decreased, and the drain was removed. Conclusions: This case suggests that intranodal lymphangiography and embolisation may not only be a diagnostic tool but can be considered as an effective, minimally invasive and safe method for the treatment of lymphoceles after kidney transplantation.
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Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore
| | | | - Fang Jann Lee
- Department of Urology, Singapore General Hospital, Singapore
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Treatment Outcomes in Patients With Symptomatic Lymphoceles Following Radical Prostatectomy Depend Upon Size and Presence of Infection. Urology 2020; 143:181-185. [DOI: 10.1016/j.urology.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/10/2020] [Accepted: 06/07/2020] [Indexed: 11/22/2022]
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Kim SW, Hur S, Kim SY, Cho JY, Kwak C, Kim HS, Ha J, Min SK, Lee M, Kim HC, Jae HJ, Chung JW. The Efficacy of Lymph Node Embolization Using N-Butyl Cyanoacrylate Compared to Ethanol Sclerotherapy in the Management of Symptomatic Lymphorrhea after Pelvic Surgery. J Vasc Interv Radiol 2019; 30:195-202.e1. [PMID: 30717950 DOI: 10.1016/j.jvir.2018.09.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/06/2018] [Accepted: 09/29/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare the efficacy of lymph node (LN) embolization using N-butyl cyanoacrylate versus ethanol sclerotherapy in the management of symptomatic postoperative pelvic lymphorrhea. MATERIALS AND METHODS Thirty-three patients with 40 instances of symptomatic postoperative lymphorrhea were treated with either LN embolization or sclerotherapy at Seoul National University Hospital from January 2009 to July 2017 and were retrospectively included (LN embolization group: 24 lymphoceles of 19 patients, mean age of 59.29 years; sclerotherapy group: 16 lymphoceles of 14 patients, mean age of 60.95 years). The types of operations were hysterectomy and bilateral oophorectomy with pelvic lymph node dissection (n = 9), radical prostatectomy (n = 3), and renal transplantation (n = 2) for the sclerotherapy group and radical prostatectomy (n = 10) and hysterectomy and bilateral oophorectomy with pelvic lymph node dissection (n = 9) for the LN embolization group. The 3 most common indications of treatment were lower extremity edema (n = 11), pain (n = 11), and fever (n = 8). The amount of leak before treatment (initial daily drainage) and clinical outcomes, including the clinical success rate in 3 weeks, treatment period, and complication rate were compared between both groups. RESULTS LN embolization showed a higher 3-week clinical success rate than sclerotherapy in a univariate analysis (83.3% and 43.8%, P = .026). There was no statistically significant difference in the treatment period and the complication rate (7.1 days and 12.3 days, P = .098; 8.3% and 25.0%, P = .184). CONCLUSIONS LN embolization is more effective for treating postoperative pelvic lymphorrhea than sclerotherapy with similar safety.
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Affiliation(s)
- Se Woo Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea.
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
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14
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Dräger DL, Schmidt S. [Wound drainage after inguinal lymphadenectomy in malignant diseases]. Urologe A 2019; 58:555-558. [PMID: 30968174 DOI: 10.1007/s00120-019-0920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D L Dräger
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland. .,UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland.
| | - S Schmidt
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland
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15
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Chu HH, Shin JH, Kim JW, Noh SY, Yang WJ, Park S. Lymphangiography and Lymphatic Embolization for the Management of Pelvic Lymphocele After Radical Prostatectomy in Prostatic Cancer. Cardiovasc Intervent Radiol 2019; 42:873-879. [PMID: 30919025 DOI: 10.1007/s00270-019-02209-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To retrospectively evaluate the short-term outcomes of lymphangiography and lymphatic embolization in the treatment of pelvic lymphocele after radical prostatectomy in patients with prostate cancer. MATERIALS AND METHODS The data of nine, consecutive patients who underwent lymphangiography and lymphatic embolization for pelvic lymphocele after radical prostatectomy with pelvic lymph node dissection (PLND) between January 2016 and May 2018, were retrospectively reviewed. Lymphangiography was performed through inguinal lymph nodes in order to identify the lymphatic leakage. When a leakage was found, lymphatic embolization was performed using a directly punctured fine needle at the closest upstream lymph node or lymphopseudoaneurysm and with N-butyl cyanoacrylate glue. RESULTS Lymphangiography demonstrated extravasation and/or lymphopseudoaneurysm in all of these patients. A total of 13 sessions of lymphangiography and lymphatic embolization were performed. The median number of lymphangiography and lymphatic embolizations required to achieve clinical success was one (range, 1-3). Three patients underwent repeated embolization with successful results. The technical and clinical success rates were 100%, respectively. The median time to resolution was 7 days (range, 2-19 days). There was no recurrence and no procedure-related complications during the follow-up period (mean, 26 weeks; range, 8-77 weeks) in all patients. CONCLUSIONS Lymphangiography and lymphatic embolization are safe and effective for the management of pelvic lymphoceles after radical prostatectomy with PLND.
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Affiliation(s)
- Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seung Yeon Noh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Woo Jin Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Suyoung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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16
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Bounds MC, Endean ED. Reply. J Vasc Surg Venous Lymphat Disord 2019; 7:310-311. [PMID: 30771836 DOI: 10.1016/j.jvsv.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Michael C Bounds
- Section of Vascular Surgery, Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Ky
| | - Eric D Endean
- Section of Vascular Surgery, Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Ky
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Fisher JA, Bundy JJ, Gemmete JJ, Srinivasa RN, Chick JFB. Regarding "Treatment of postoperative high-volume lymphatic complications using isosulfan blue". J Vasc Surg Venous Lymphat Disord 2019; 7:309-310. [PMID: 30771835 DOI: 10.1016/j.jvsv.2018.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jason A Fisher
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob J Bundy
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich
| | - Joseph J Gemmete
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich
| | - Ravi N Srinivasa
- Department of Interventional Radiology, University of California, Los Angeles, Calif
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18
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Han K, Seo SK, Kim MD, Kim GM, Kwon JH, Kim HJ, Won JY, Lee DY. Catheter-directed Sclerotherapy for Ovarian Endometrioma: Short-term Outcomes. Radiology 2018; 289:854-859. [PMID: 30152743 DOI: 10.1148/radiol.2018180606] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Purpose To evaluate the effectiveness of catheter-directed sclerotherapy (CDS) with 95% ethanol in patients with primary or recurrent ovarian endometriomas. Materials and Methods In this prospective study, 14 participants (mean age, 32 years; range, 20-44 years) who underwent CDS for ovarian endometrioma from March 2015 to December 2017 were evaluated. Diagnosis was based on symptoms and imaging studies. To assess the impact of CDS on ovarian reserve, serum anti-Müllerian hormone (AMH) was measured before CDS and 6 months after CDS. Serum cancer antigen 125 (CA-125) levels were also measured at the same time points. Follow-up US was performed 1, 3, and 6 months after CDS and biannually thereafter to monitor potential cyst size change and recurrence. Comparison of AMH, CA-125, and cyst size before and after CDS was performed by using the paired t test or Wilcoxon signed-rank test. Results Mean endometrioma size decreased from 5.8 cm ± 2.2 to 1.1 cm ± 1 (P ˂ .001). During a mean follow-up of 12.7 months (range, 6.1-23.0 months), there were no recurrences of endometrioma. Pain was relieved in all participants, with a decrease in serum CA-125 level (P = .001). There was no difference in serum AMH level before and 6 months after CDS, indicating well-preserved ovarian function (4.29 ng/mL ± 2.47 vs 4.36 ng/mL ± 1.94, respectively; P > .875). There were no procedure-related complications. Conclusion Catheter-based sclerotherapy with 95% ethanol can lead to better short-term clinical outcomes and well-preserved ovarian function for patients with endometriomas. © RSNA, 2018.
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Affiliation(s)
- Kichang Han
- From the Department of Radiology (K.H., M.D.K., G.M.K., J.H.K., H.J.K., J.Y.W., D.Y.L.) and Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology (S.K.S.), Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Seok Kyo Seo
- From the Department of Radiology (K.H., M.D.K., G.M.K., J.H.K., H.J.K., J.Y.W., D.Y.L.) and Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology (S.K.S.), Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Man-Deuk Kim
- From the Department of Radiology (K.H., M.D.K., G.M.K., J.H.K., H.J.K., J.Y.W., D.Y.L.) and Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology (S.K.S.), Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Gyoung Min Kim
- From the Department of Radiology (K.H., M.D.K., G.M.K., J.H.K., H.J.K., J.Y.W., D.Y.L.) and Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology (S.K.S.), Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Joon Ho Kwon
- From the Department of Radiology (K.H., M.D.K., G.M.K., J.H.K., H.J.K., J.Y.W., D.Y.L.) and Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology (S.K.S.), Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Hee Joon Kim
- From the Department of Radiology (K.H., M.D.K., G.M.K., J.H.K., H.J.K., J.Y.W., D.Y.L.) and Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology (S.K.S.), Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Jong Yun Won
- From the Department of Radiology (K.H., M.D.K., G.M.K., J.H.K., H.J.K., J.Y.W., D.Y.L.) and Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology (S.K.S.), Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Do Yun Lee
- From the Department of Radiology (K.H., M.D.K., G.M.K., J.H.K., H.J.K., J.Y.W., D.Y.L.) and Division of Gynecologic Endocrinology, Department of Obstetrics and Gynecology (S.K.S.), Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
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Joubert C, Monchal T, Junca-Laplace C, Sellier A, Beucler N, Fesselet J, Balandraud P, Dagain A. Management of Chyloretroperitoneum After Lumbar Surgery by Anterior Approach. World Neurosurg 2018; 122:e1211-e1221. [PMID: 30447468 DOI: 10.1016/j.wneu.2018.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anterior lumbar approach, routinely used in spinal surgery, provides many advantages, specifically avoidance of manipulation and potential injury to nervous system structures; it also provides indirect central and foraminal decompression, with a complication rate of 1%-3%. Chyloretroperitoneum is a rare complication of spinal procedures using anterior lumbar approach. The aim of this study was to discuss diagnosis, treatment, and management of chyloretroperitoneum based on review of the international literature through 2017. METHODS The literature review was conducted using the terms "chyloretroperitoneum," "spinal surgery," and "lymphocele." Additionally, an illustrative case of chyloretroperitoneum following anterior retroperitoneal lumbar approach was presented. RESULTS In 33 cases, including the present case, clinical symptoms appeared after discharge in 75.8% (n = 25) and reflected direct mass effect. Abdominopelvic computed tomography permitted assessment of the fluid collection observed as a hypodense collection around the psoas muscle. In 24 cases, drainage of the chyloretroperitoneum was maintained for a mean duration of 2.9 days. Surgery was performed in 14 patients (42.4%) owing to lymphatic collection. In 5 cases, surgery was performed for direct lymphatic vessel treatment. Laparoscopic marsupialization of the collection and peritoneal fenestration were performed, especially after percutaneous drainage failure. CONCLUSIONS Computed tomography was the most useful imaging modality for diagnosis and assessment of associated complications. If puncture alone is not sufficient and should be avoided, percutaneous computed tomography-guided drainage with sclerosing agent administration appears to be a safe and efficient first-line treatment. Laparoscopic fenestration should be used in cases of complicated or recurrent lymphoceles.
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Affiliation(s)
- Christophe Joubert
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France.
| | - Tristan Monchal
- Department of Oncologic and General Surgery, Sainte Anne Military Hospital, Toulon, France
| | | | - Aurore Sellier
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - Nathan Beucler
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - Jacques Fesselet
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France
| | - Paul Balandraud
- Department of Oncologic and General Surgery, Sainte Anne Military Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France
| | - Arnaud Dagain
- Department of Neurosurgery, Sainte Anne Military Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France
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20
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Al Daoud F, Thayer A, Sachwani Daswani G, Maraqa T, Perinjelil V, Mercer L. Management of chronic abdominal wall seroma with Doxycycline sclerotherapy using a Negative Pressure Wound Therapy System KCI-V.A.C.Ulta™-A case report. Int J Surg Case Rep 2018; 51:25-28. [PMID: 30130670 PMCID: PMC6104591 DOI: 10.1016/j.ijscr.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Seroma is a common and challenging post-operative complication that surgeons are often faced with after performing procedures in which tissue dead spaces have been created. The management strategies consist of non-operative management, percutaneous drainage, or surgical drainage. Our case report discusses the use of Doxycycline sclerotherapy in the successful resolution of a chronic abdominal wall seroma. PRESENTATION OF CASE We present the case of a 50 year old patient with extensive history of multiple abdominal surgeries, including appendectomy, multiple hernia repairs with recurrent mesh replacement as a result of infection followed by post-operative formation of seroma after each repair. Recently, patient underwent panniculecotomy complicated by seroma that was successfully resolved with the use of doxycycline sclerotherapy. DISCUSSION Sclerotherapy has been used previously in the surgical field such as thoracic surgery, as a successful use of sclerosants in chronic pleural effusions has been documented. Sclerosants range from talc, tetracycline antibiotics, ethanol, polidocanol, erythromycin, OK-432, fibrin glue, and povidone-iodine, and are largely safe and easily applicable. Doxycycline in particular can be a simple and effective method for resolution of chronic seroma. This case demonstrates the successful use of doxycycline in the resolution of a chronic abdominal wall seroma. CONCLUSION Chronic and recurrent seroma after surgery can be difficult to deal with. Using sclerosants such as Doxycycline would be an effective solution to treat this chronic issue and to prevent its recurrence especially if it is used with a Negative Pressure Wound Therapy System.
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Affiliation(s)
- Fadi Al Daoud
- 1 Hurley Plaza, 7 B Trauma Services, Flint, MI, 48503, USA.
| | - Angelyn Thayer
- 1 Hurley Plaza, 7 B Trauma Services, Flint, MI, 48503, USA.
| | | | - Tareq Maraqa
- 1 Hurley Plaza, 7 B Trauma Services, Flint, MI, 48503, USA.
| | | | - Leo Mercer
- 1 Hurley Plaza, 7 B Trauma Services, Flint, MI, 48503, USA.
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21
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Srinivasa RN, Chick JFB, Patel N, Gemmete JJ, Srinivasa RN. Transinguinal interstitial (intranodal) lymphatic embolization to treat high-output postoperative lymphocele. J Vasc Surg Venous Lymphat Disord 2018; 6:373-375. [DOI: 10.1016/j.jvsv.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/02/2018] [Indexed: 10/17/2022]
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22
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Srinivasa RN, Chick JFB. Regarding "Incidence and risk factors of groin lymphocele formation after venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients". J Vasc Surg 2018; 67:1317. [PMID: 29579476 DOI: 10.1016/j.jvs.2017.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/26/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Ravi N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, Mich
| | - Jeffrey Forris Beecham Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, Mich
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23
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Salna M, Morrissey N, Takeda K. Reply. J Vasc Surg 2018; 67:1317-1318. [PMID: 29579475 DOI: 10.1016/j.jvs.2017.10.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Salna
- Department of Cardiothoracic Surgery, Stanford University Hospital, Stanford, Calif
| | - Nicholas Morrissey
- Division of Vascular Surgery, Columbia University Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
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Akhan O, Dagoglu-Kartal MG, Ciftci T, Ozer C, Erbahceci A, Akinci D. Percutaneous Treatment of Non-parasitic Splenic Cysts: Long-Term Results for Single- Versus Multiple-Session Treatment. Cardiovasc Intervent Radiol 2017; 40:1421-1430. [PMID: 28462445 DOI: 10.1007/s00270-017-1650-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to investigate the efficacy and safety of percutaneous sclerotherapy for non-parasitic splenic cysts (NPSCs). The secondary aims were to introduce puncture-aspiration-injection-reaspiration (PAIR) technique in the treatment of NPSCs and to compare multiple- and single-session techniques. MATERIALS AND METHODS This retrospective study included 24 (17 females, 7 males) patients, treated between the years 1997 and 2015. Three techniques were used. Group A (n = 8), Group B (n = 6) and Group C (n = 10) were treated by PAIR, single-session catheterization and multiple-session catheterization, respectively. Since both PAIR and single-session catheterization techniques are carried out in a single session, Group A and Group B were evaluated in one group (Group A + B). Group A + B was compared with Group C in terms of patient demographics, the initial volume of the cysts, follow-up periods, complication and hospitalization rates and follow-up results. Recurrence and reduction rates were evaluated for two groups. RESULTS Technical success rate was 100%. The mean follow-up period was 68.9 months. Recurrence detected in 7 (29.1%) patients. Final reduction rate was between 40.7 and 100% (median 96.4%) with a significant difference in cyst volume (p < 0.05). There was no significant difference regarding recurrence rates (p = 1) and the final reduction rates (p = 0.51) between the two groups. CONCLUSION Percutaneous sclerotherapy is a minimally invasive technique, preserving maximum tissue while effectively treating NPSCs. Single-session sclerotherapy which reduces hospitalization days and increases patient comfort is as effective as multi-session sclerotherapy as the initial procedure. This study supports that single-session sclerotherapy should be a valid treatment option.
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Affiliation(s)
- Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, 6100, Sihhiye, Ankara, Turkey.
| | | | - Turkmen Ciftci
- Department of Radiology, Hacettepe University School of Medicine, 6100, Sihhiye, Ankara, Turkey
| | - Cigdem Ozer
- Numune Training and Research Hospital Radiology Clinic, Ülkü Mahallesi Talatpaşa Bulvari No: 5, Altindag, 6080, Ankara, Turkey
| | - Aysun Erbahceci
- Sadi Konuk Training and Research Hospital Radiology Clinic, Tevfik Saglam Caddesi No: 11, Zuhuratbaba, 34147, Istanbul, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, 6100, Sihhiye, Ankara, Turkey
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Pelvic Peritoneal Inclusion Cyst: Ultrasound Diagnosis and Management. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lymphatic Embolization for the Treatment of Pelvic Lymphoceles: Preliminary Experience in Five Patients. J Vasc Interv Radiol 2016; 27:1170-6. [DOI: 10.1016/j.jvir.2016.04.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 12/27/2022] Open
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Pucheril D, Campbell L, Bauer RM, Montorsi F, Sammon JD, Schlomm T. A Clinician's Guide to Avoiding and Managing Common Complications During and After Robot-assisted Laparoscopic Radical Prostatectomy. Eur Urol Focus 2016; 2:30-48. [PMID: 28723448 DOI: 10.1016/j.euf.2016.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 01/21/2023]
Abstract
CONTEXT Robot-assisted radical prostatectomy (RARP) is on the advance globally, and it is essential for surgeons and patients to know the rates of perioperative complications. OBJECTIVE To provide evidence-based clinical guidance on avoiding and managing common complications during and after RARP in the context of a comprehensive literature review. EVIDENCE ACQUISITION In concordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis 2015 statement guidelines, a literature search of the PubMed database from August 1, 2011, to August 31, 2015, using the predefined search terms robot* AND radical prostatectomy, was conducted. The search resulted in 653 unique results that were subsequently uploaded to DistillerSR (Evidence Partners, Ottawa, Canada) for team-based screening and processing of references. EVIDENCE SYNTHESIS Overall, 37 studies met the inclusion criteria and were included. Median rate of overall complication was 12.6% (range: 3.1-42%). Most of the complications were minor (Clavien-Dindo grades 1 and 2). Grade 3 complications comprised the bulk of the major complications with a median rate of 2.7%; grade IV and V complications were exceedingly rare in all reports. CONCLUSIONS Despite continued adoption of the RARP technique globally, rates of overall complication remain low. Many of the complications experienced during and after RARP can be mitigated and prevented by experience and the implementation of safe techniques. PATIENT SUMMARY Despite continued adoption of the robot-assisted radical prostatectomy (RARP) technique globally, rates of overall and major complications remain low at 12.6% and 2.7%, respectively. Complications can be minimized and successfully managed using established techniques. RARP is a safe and reproducible technique.
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Affiliation(s)
- Daniel Pucheril
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA.
| | - Logan Campbell
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA
| | - Ricarda M Bauer
- Department of Urology, Ludwig Maximilian University, Munich, Germany
| | - Francesco Montorsi
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Jesse D Sammon
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA
| | - Thorsten Schlomm
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kim BS, Kwon TG. Chylous ascites in laparoscopic renal surgery: Where do we stand? World J Clin Urol 2016; 5:37-44. [DOI: 10.5410/wjcu.v5.i1.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/30/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Postoperative chylous ascites, which is caused by the disruption of lymphatic channels and persistent lymphatic leakage, was a rare complication in the urologic field before laparoscopic surgery was introduced. Now that laparoscopic urologic surgery, especially laparoscopic nephrectomy, is widely performed, chylous ascites as a complication of laparoscopic renal surgery has been reported more frequently. With these accumulated experiences and data comes knowledge about the proper diagnosis and management of chylous ascites, although there is still some debate regarding the correct protocol for diagnosis and management. Therefore, we performed a systematic review of the current literature regarding the etiology, incidence, diagnosis, management, and prognosis of chylous ascites after laparoscopic renal surgery, as well as strategies used to prevent it, and discuss current perspectives on overcoming this complication in the laparoscopic age.
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Lee HJ, Kane CJ. How to minimize lymphoceles and treat clinically symptomatic lymphoceles after radical prostatectomy. Curr Urol Rep 2015; 15:445. [PMID: 25129450 DOI: 10.1007/s11934-014-0445-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The development of a lymphocele after pelvic surgery is a well-documented complication, especially where pelvic lymph node dissection (PLND) is part of the operation. However, not all lymphoceles are symptomatic and require treatment. Most lymphoceles spontaneously resolve, and even lymphoceles that become symptomatic may resolve without any intervention. Robotic assisted radical prostatectomy (RARP) is a common operation in urology where PLND is likely to be performed in intermediate and high-risk prostate cancer patients. The rationale for performing a PLND in prostate cancer is for accurate staging and potential therapeutic benefits. However, due to potential intraoperative and postoperative complications there is still a debate regarding the value of PLND in prostate cancer. In this review, we will discuss the potential risk factors to be aware of in pelvic surgery in order to minimize the formation of a lymphocele, along with the management for clinically significant lymphoceles.
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Affiliation(s)
- Hak J Lee
- Department of Urology, UC San Diego Health Systems, 200 West Arbor Drive, # 8897, San Diego, CA, 92103, USA,
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Köhler C, Kyeyamwa S, Marnitz S, Tsunoda A, Vercelino F, Schneider A, Favero G. Prevention of lymphoceles using FloSeal and CoSeal after laparoscopic lymphadenectomy in patients with gynecologic malignancies. J Minim Invasive Gynecol 2014; 22:451-5. [PMID: 25499774 DOI: 10.1016/j.jmig.2014.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pelvic ± para-aortic lymphadenectomy (LAE) is an essential element of staging and treatment of different gynecologic malignancies. However, LAE can induce asymptomatic and symptomatic pelvic lymphoceles (LCs) in a considerable percentage of patients. Therapy of symptomatic LCs may cause additional morbidity. The best strategy to reduce the rate of LCs has not established yet. MATERIALS AND METHODS Between January 2011 and May 2012, transperitoneal laparoscopic pelvic ± para-aortic LAE was performed at the Department of Gynecology at Charité University Hospital Berlin in 238 patients with cervical, endometrial, ovarian, or groin-positive vulvar cancer. The application of FloSeal (Baxter, Deerfield, IL) and CoSeal (Baxter) was used in 25 patients (group A) as an alternative to routine pelvic drainage after LAE. A case-control comparison was performed on 25 patients (group B) with bilateral drainage after complete LAE. The primary objective of this pilot study was to evaluate the feasibility and safety of the method. As a secondary objective, we evaluated the incidence of LCs and symptomatic LCs in both groups. The detection of LCs was performed during oncologic follow-up by sonography, computed tomographic imaging, or magnetic resonance imaging. MEASUREMENTS AND MAIN RESULTS Pelvic (n = 50) or pelvic + para-aortic (n = 42) LAE was performed in 44 patients with cervical, 2 with endometrial, 1 with ovarian, and 2 with groin-positive vulvar cancer, respectively. In group B (n = 25), systematic bilateral pelvic drainage was placed after finishing LAE, whereas in group A (n = 25) LAE areas were sealed with 5 mL FloSeal on each side and sprayed with CoSeal afterward without placing drains. In 14 of 50 patients (28%), LCs were detected. In a subgroup of patients with cervical cancer (88% of the cohort), symptomatic LCs occurred in 11% in group A and 18% in group B. Operative revision of symptomatic LCs was necessary in 5% and 18% in groups A and B, respectively (p = .66). Mean Hospital stay was significant shorter in group A (6 days) versus B (8 days) (p = .027). CONCLUSION The results of this case-controlled pilot study indicate that the application of FloSeal and CoSeal after transperitoneal LAE is feasible and safe, may reduce hospital stay, and may potentially decrease the rate of symptomatic LCs in patients with gynecologic malignancies.
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Affiliation(s)
- Christhardt Köhler
- Department of Operative and Oncologic Gynecology, Asklepios Clinic, Hamburg, Germany
| | - Sarah Kyeyamwa
- Department of Gynecology, Charité Universitt of Gynec, Berlin, Germany
| | - Simone Marnitz
- Department of Radiooncology, Charité Universitt of Radio, Berlin, Germany
| | - Audrey Tsunoda
- Department of Gynecologic Oncology, Cancer Centre Barretos, Barretos, Brazil
| | | | - Achim Schneider
- Institute for Cytologie and Dyplasia, Füytologie and Dyp, Berlin, Germany
| | - Giovanni Favero
- Department of Operative and Oncologic Gynecology, Asklepios Clinic, Hamburg, Germany.
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Lee EW, Shin JH, Ko HK, Park J, Kim SH, Sung KB. Lymphangiography to treat postoperative lymphatic leakage: a technical review. Korean J Radiol 2014; 15:724-32. [PMID: 25469083 PMCID: PMC4248627 DOI: 10.3348/kjr.2014.15.6.724] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/02/2014] [Indexed: 11/15/2022] Open
Abstract
In addition to imaging the lymphatics and detecting various types of lymphatic leakage, lymphangiography is a therapeutic option for patients with chylothorax, chylous ascites, and lymphatic fistula. Percutaneous thoracic duct embolization, transabdominal catheterization of the cisterna chyli or thoracic duct, and subsequent embolization of the thoracic duct is an alternative to surgical ligation of the thoracic duct. In this pictorial review, we present the detailed technique, clinical applications, and complications of lymphangiography and thoracic duct embolization.
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Affiliation(s)
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Heung Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Jihong Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Soo Hwan Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Bleomycin sclerotherapy for severe symptomatic and persistent pelvic lymphocele. Case Rep Obstet Gynecol 2014; 2014:624803. [PMID: 25105040 PMCID: PMC4109129 DOI: 10.1155/2014/624803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/28/2014] [Accepted: 06/11/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Pelvic lymphoceles are frequently described as a complication of pelvic lymphadenectomy performed for surgical staging of gynaecologic malignancies. Case Report. A 72-year-old woman presented with severe symptomatic and refractory lymphocele associated with persistent lower limb lymphedema and recurrent erysipelas. After four CT fluoroscopy scan guided percutaneous catheter drainages, the lymphocele complicated with infection finally resolved with two sessions of bleomycin sclerotherapy. Conclusion. Symptomatic persistent lymphoceles require treatment and nowadays the first option is interventional radiologic procedures. Bleomycin is a safe and effective sclerosing agent and therefore should be regarded as a first-line treatment choice.
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Radosa MP, Diebolder H, Camara O, Mothes A, Anschuetz J, Runnebaum IB. Laparoscopic lymphocele fenestration in gynaecological cancer patients after retroperitoneal lymph node dissection as a first-line treatment option. BJOG 2013; 120:628-36. [DOI: 10.1111/1471-0528.12103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 11/28/2022]
Affiliation(s)
- MP Radosa
- Department of Gynaecology and Obstetrics; Jena University Hospital; Germany
| | - H Diebolder
- Department of Gynaecology and Obstetrics; Jena University Hospital; Germany
| | - O Camara
- Department of Gynaecology and Obstetrics; Jena University Hospital; Germany
| | - A Mothes
- Department of Gynaecology and Obstetrics; Jena University Hospital; Germany
| | - J Anschuetz
- Department of Gynaecology and Obstetrics; Jena University Hospital; Germany
| | - IB Runnebaum
- Department of Gynaecology and Obstetrics; Jena University Hospital; Germany
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Management of postoperative lymphoceles after lymphadenectomy: percutaneous catheter drainage with and without povidone-iodine sclerotherapy. Cardiovasc Intervent Radiol 2012; 36:466-71. [PMID: 22484702 DOI: 10.1007/s00270-012-0375-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To report our single-center experience in managing symptomatic lymphoceles after lymphadenectomy for genitourinary and gynecologic malignancy and to compare clinical outcomes of percutaneous catheter drainage (PCD) alone versus PCD with transcatheter povidone-iodine sclerotherapy (TPIS). METHODS The medical records of patients who presented for percutaneous drainage of pelvic lymphoceles from February 1999 to September 2007 were retrospectively reviewed. Catheters with prolonged outputs >50 cc/day were treated with TPIS. Technical success was defined as the ability to achieve complete resolution of the lymphocele. Clinical success was defined as resolution of the patient's symptoms that prompted the intervention. RESULTS Sixty-four patients with 70 pelvic lymphoceles were treated. Forty-six patients (71.9 %) had PCD, and 18 patients (28.1 %) had multisession TPIS. The mean initial cavity size was 294.9 cc for those treated with TPIS and 228.2 cc for those treated with PCD alone (range 15-1,600) (p = 0.59). Mean duration of catheter drainage was 19 days (29 days with TPIS, 16 days with PCD, p = 0.001). Mean clinical follow-up was 22.6 months. Technical success was 74.3 % with PCD and 100 % with TPIS. Clinical success was 97 % with PCD and 100 % with TPIS. Postprocedural complications included pericatheter fluid leakage (n = 4), catheter dislodgement (n = 3), catheter occlusion (n = 9), and secondary infection of the collection (n = 4). CONCLUSION PCD of symptomatic lymphoceles is an effective postoperative management technique. Initial cavity size is not an accurate predictor of the need for TPIS. When indicated, TPIS is safe and effective with catheter outputs >50 cc/day.
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Lee SW, Lee SJ, Jang DG, Yoon JH, Kim JH. Comparison of laparoscopic and laparotomic surgery for the treatment of peritoneal inclusion cyst. Int J Med Sci 2012; 9:14-9. [PMID: 22211084 PMCID: PMC3222085 DOI: 10.7150/ijms.9.14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/26/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. The objective of this study is to compare between the laparoscopic and laparotomic surgery for the treatment of PIC. METHODS Thirty-five patients with laparoscopy and forty-eight patients with laparotomy were included in the study. We compared the perioperative and postoperative data, the complications and the recurrence between the two groups. RESULTS There was a significantly reduced mean length of the hospital stay, estimated blood loss and complication rate in the laparoscopic group as compared to that of the laparotomic group (P=0.037, P=0.047 and P=0.037 respectively). There was also no statistical difference of recurrence rate between thelaparoscopic and laparotomic groups on the Cox proportional hazards model (p=0.209). CONCLUSION Our study showed that laparoscopy was superior to the laparotomy for the mean estimated blood loss, the mean length of the hospital stay and the complication rate except for the recurrence rate.
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Affiliation(s)
- Suk Woo Lee
- Department of Obstetrics and Gynecology, The Catholic University of Medicine, Korea
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Tinelli A, Giorda G, Manca C, Pellegrino M, Prudenzano R, Guido M, Dell'edera D, Malvasi A. Prevention of lymphocele in female pelvic lymphadenectomy by a collagen patch coated with the human coagulation factors: A pilot study. J Surg Oncol 2011; 105:835-40. [DOI: 10.1002/jso.22110] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 09/10/2011] [Indexed: 11/07/2022]
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Kim BS, Yoo ES, Kim TH, Kwon TG. Chylous ascites as a complication of laparoscopic nephrectomy. J Urol 2010; 184:570-4. [PMID: 20639020 DOI: 10.1016/j.juro.2010.03.128] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Indexed: 01/02/2023]
Abstract
PURPOSE Chylous ascites is a rare complication after major retroperitoneal surgery. Recently chylous ascites has developed more often after laparoscopic nephrectomy since that is increasingly done for various indications at many centers. We reviewed our cases of chylous ascites after laparoscopic nephrectomy. MATERIALS AND METHODS Between January 2002 and December 2008 we performed 622 transperitoneal laparoscopic nephrectomies. We retrospectively analyzed factors related to chylous ascites as a complication of laparoscopic nephrectomy. RESULTS The overall incidence of chylous ascites was 5.1% (32 of 622 cases), including 4 severe refractory cases (0.6%). The difference in incidence by operation type was not statistically different (p = 0.251). Chylous ascites developed more often after left than right nephrectomy (7.3% or 25 of 343 cases vs 2.5% or 7 of 279, p = 0.010). In patients with radical nephrectomy and nephroureterectomy the incidence was higher in those who did vs did not undergo lymphadenectomy (13.9% or 10 of 72 vs 4.0% or 11 of 275, p = 0.027). Only 1 patient underwent explorative laparotomy due to persistent severe chylous ascites despite 8-week conservative management. The other cases were successfully managed conservatively by total parenteral nutrition and a low fat diet. CONCLUSIONS Chylous ascites is not a rare complication after laparoscopic nephrectomy and most cases can be managed conservatively. To prospectively prevent this complication we recommend meticulous clipping of all perihilar and retroperitoneal fibrous fatty tissue during major vessel dissection, especially for left nephrectomy or extensive lymphadenectomy.
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Affiliation(s)
- Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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Mahrer A, Ramchandani P, Trerotola SO, Shlansky-Goldberg RD, Itkin M. Sclerotherapy in the management of postoperative lymphocele. J Vasc Interv Radiol 2010; 21:1050-3. [PMID: 20537556 DOI: 10.1016/j.jvir.2010.03.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Revised: 03/05/2010] [Accepted: 03/14/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To describe a single-center experience with sclerotherapy of postoperative lymphocele and to determine the risk factors for failure of treatment. MATERIALS AND METHODS From 1999 to 2007, 43 patients with postsurgical lymphocele were treated with sclerotherapy with a combination of povidone iodine, alcohol, and doxycycline. The treatments were repeated at weekly intervals. The initial drainage volume of the lymphocele, the location of the lymphocele, the number of treatments, and the outcomes were retrospectively collected. RESULTS In 38 patients, the lymphocele was drained percutaneously, and in five patients, the treatment was initiated through an existing surgically placed drainage tube. Sclerotherapy was successful in 33 patients (77%). Complications that resulted in termination of the treatment were seen in five patients (12%): testicular pain, cellulitis, posttreatment increase in creatinine, acute renal tubular necrosis, and abdominal infection. In one of these patients the lymphocele resolved after resolution of the infection. The average number of treatments was four (range, 1-14). There was no difference in success rate between superficial intraabdominal and soft-tissue lymphoceles. There was a significant difference (P < .05) in the fluid volume at initial drainage between the failure group (1,708 mL +/- 1,521) and the success group (206 mL +/- 213). This assumes an attempt was made to drain the collection completely at the initial procedure. CONCLUSIONS Sclerotherapy of postoperative lymphoceles is an effective treatment. Success of sclerotherapy is directly related to the size of the lymphocele cavity.
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Affiliation(s)
- Arie Mahrer
- Department of Radiology, Stratton Veterans Affairs Medical Center, Albany, New York, USA
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Ulrich F, Niedzwiecki S, Fikatas P, Nebrig M, Schmidt SC, Kohler S, Weiss S, Schumacher G, Pascher A, Reinke P, Tullius SG, Pratschke J. Symptomatic lymphoceles after kidney transplantation - multivariate analysis of risk factors and outcome after laparoscopic fenestration. Clin Transplant 2009; 24:273-80. [DOI: 10.1111/j.1399-0012.2009.01073.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lim HK, Cho JY, Kim SH. Sclerotherapy of peritoneal inclusion cysts: a long-term evaluation study. ACTA ACUST UNITED AC 2009; 35:431-6. [DOI: 10.1007/s00261-009-9538-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 04/30/2009] [Indexed: 12/31/2022]
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Ho KY, Brugge WR. EUS 2008 Working Group document: evaluation of EUS-guided pancreatic-cyst ablation. Gastrointest Endosc 2009; 69:S22-7. [PMID: 19179162 DOI: 10.1016/j.gie.2008.10.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 10/28/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Khek-Yu Ho
- Department of Medicine, National University Hospital, Singapore
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Childs DD, Tchelepi H. Ultrasound and Abdominal Intervention: New Luster on an Old Gem. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.cult.2009.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Shih J, Trerotola SO, Itkin M. The Lymphocele PILL: A Case Report of Percutaneous Imaging-guided Lymphatic Ligation for the Treatment of Postsurgical Lymph Collections. J Vasc Interv Radiol 2008; 19:1781-4. [DOI: 10.1016/j.jvir.2008.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 08/14/2008] [Accepted: 08/18/2008] [Indexed: 10/21/2022] Open
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Tam KF, Lam KW, Chan KK, Ngan HYS. Natural history of pelvic lymphocysts as observed by ultrasonography after bilateral pelvic lymphadenectomy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:87-90. [PMID: 18548478 DOI: 10.1002/uog.5345] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To determine, in patients who have undergone bilateral pelvic lymphadenectomy for gynecological cancer, the incidence of lymphocyst formation, their change in size with time, risk factors and correlation with symptoms. METHODS This was a prospective observational study of 108 patients undergoing bilateral pelvic lymphadenectomy for gynecological cancer in our unit. We performed serial three-dimensional (3D) ultrasound assessment at 2 and 6 weeks and 3, 6, 9 and 12 months after surgery. Before each ultrasound assessment, symptoms were recorded and a physical examination was performed. RESULTS Forty-eight (44.4%) patients had unilateral or bilateral lymphocysts detected during the follow-up period; 26 were on the left side, 16 were on the right side and six were bilateral. In 39 (81.2%) of the patients, the lymphocysts were first noted 2 weeks after the operation. In nine (18.8%) the lymphocysts persisted until 12 months after surgery. There was no association between lymphocyst formation and diagnosis, type of operation performed, surgeon, operative blood loss, adjuvant radiotherapy and number of lymph nodes removed. Four lymphocysts were detected by physical examination before the ultrasound diagnosis. There was no association between lymphocyst and symptoms, including pain over the abdomen, pelvis, thigh, legs or back, lymphedema, fever or symptoms of cystitis. Only one patient developed an infection of the lymphocyst, which required surgical intervention. CONCLUSION Lymphocyst formation is common following bilateral pelvic lymphadenectomy. Most patients with lymphocysts are asymptomatic and the development of major complications is rare.
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Affiliation(s)
- K F Tam
- Department of Obstetrics and Gynaecology, Gynaecological Oncology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
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