Lymphocoele: a rare and little known complication of anterior lumbar surgery

Abstract

Lymphocoele is a rare and little known complication with only a handful of reports available. We report two cases of lymphocoele after anterior lumbar surgery that have occurred in two different centres and discuss diagnosis and management options. The first case is that of a 53-year-old male patient undergoing two level anterior lumbar interbody fusion (ALIF) for disabling back pain due to disc degeneration in the context of an old spondylodiscitis. He developed a large fluid mass postoperatively. Fluid levels of creatinin were low and intravenous urography ruled out a urinoma suggesting the diagnosis of a lymphocoele. Following two unsuccessful drainage attempts he underwent a laparoscopic marsupialization. The second case was that of a 32-year-old female patient developing a large fluid mass following a L5 corpectomy for a burst fracture. She was treated successfully with insertion of a vacuum drain during 7 days. Lymphocoele is a rare complication but should be suspected if fluid collects postoperatively following anterior lumbar spine procedures. Chemical analysis of the fluid can help in diagnosis. Modern treatment consists of laparoscopic marsupialization. Lymph vessel anatomy should be borne in mind while exposing the anterior lumbar spine.

Abdominal Lymphocele Following Anterior Lumbar Interbody Fusion: A Case Report

“…Due to the lack of chylomicrons, in the lymphatic fluid below the cisterna chili, lymphocele presents with serous fluid with a unique yellow appearance. Chyloascites or chylothorax has a white milky appearance due to the incorporation of chylomicrons from the gastrointestinal tract [ 11 , 16 ].…”

“…Although lymphangiography is the gold standard for diagnosing a lymphocele, there are complications associated with this procedure such as pulmonary embolus, skin infection, skin necrosis, and lymphatic damage due to contrast use. Benefits of doing this procedure to diagnose a lymphocele are uncertain [ 6 , 8 , 11 ].…”

A comparison of complication rate between anterior and lateral approaches to the lumbar spine

“…Lymph vessels and nodes should be clearly identified and avoided. They are located lateral to the left common iliac artery and can be injured during dissection of the left ascending lumbar vein while exposing the L4-5 or L3-4 disc space 23 . The main postoperative complication in our group of ALIF patients was post-sympathectomy syndrome (16%) and the reason was usually the necessity to sacrifice the lumbar sympathetic chain to obtain wide access to the discs.…”

Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

“…Lymphocele is a rare complication. Lymph vessels are located lateral to the left common iliac artery and can be injured during dissection of the left ascending lumbar vein while exposing the L4-5 or L3-4 disc space (45).…”