Lymphatic supermicrosurgery for the treatment of recurrent lymphocele and severe lymphorrhea

Abstract

Background Lymphocele and lymphorrhea are frequent complications after lymph node excision. Recurrent lymphoceles and intractable lymphorrhea are particularly difficult to treat conservatively. We describe the outcomes of four patients with recurrent lymphocele and nine patients with persistent lymphorrhea that were treated by supermicrosurgery. Methods Four patients with recurrent lymphoceles with a size between 7 and 21 cm and located in the groin (n = 1) or upper leg (n = 3), were referred for surgical treatment between 2013 and 2017 after unsuccessful conservative therapy. Nine patients with lymphorrhea from the groin (n = 7), scrotum (n = 1), or axilla (n = 1) after lymph node or lipoma excision were referred for surgical treatment. Of these, five patients presented with a drainage system and two had a lymphocutaneous fistula. Indocyanine green (ICG) lymphography was used to visualize the lymphatic flow toward the lymphocele, to detect ruptured lymph vessels causing lymphorrhea and for preoperative lymphatic mapping. Results All 13 patients were successfully treated by one or more (mean: 3, range 1–4) lymphaticovenous anastomoses without perioperative complications. The lymphoceles resolved in all four patients, and no recurrence was recorded during follow‐up. The lymphorrhea was cured in all patients by means of lymphaticovenous anastomosis performed distal to the site of leakage. No recurrence was observed during follow‐up. The patency of the lymphaticovenous anastomosis was confirmed intraoperatively by means of ICG lymphography in all cases. Conclusion Lymphaticovenous anastomosis is a minimally invasive and effective procedure for the treatment of recurrent lymphocele and persistent lymphorrhea.

Lymphovenous anastomosis (LVA) for treatment of iatrogenic lymphocele in the thigh

“…Another correlated delicate issue is infections. In this case pain and tenderness of the involved area are typical signs, and staphylococcus is the most frequently cultured organism (Alago et al, 2013; Boccardo et al, 2014; Borud et al, 2008; Ferguson & Maclure, 1961; Giacalone et al, 2019; Karcaaltincaba & Akhan, 2005; Roberts et al, 1993; Van den Brande et al, 2012; Vilain & Dardour, 1986).…”

A New Planning Method to Easily Harvest the Superficial Circumflex Iliac Artery Perforator Flap

“…The superficial planes of elevation may reduce the risk of lymphatic injuries and postoperative lymphoceles or lymphorrea. 25 In different series, this perforator is used and is preferably chosen by the authors. We have noticed that after penetrating the deep fascia, the medial perforator has a course within the deep-fat layer and generally provides some branches to the inguinal lymph nodes before penetrating the superficial fascia; afterward it travels through the superficial fat layer toward the anterior superior iliac spine.…”

Long term outcomes from lymphatic venous anastomosis after total hysterectomy to prevent postoperative lymphedema in lower limb

“…It is assumed that direct lymphaticovenous anastomosis followed by a hysterectomy and lymphadenectomy is effective to prevent postoperative lymphedema. This approach would not only reduce the risk of lymphedema, but also reduce the risk of lymphocele [26, 27]. Potential problem we recognized at surgery, however, is that surgical results significantly depended on each surgeon using a microscope.…”