The role of lymphatic interventional radiology for postoperative lymphorrhea

Abstract

Lymphorrhea after gastrointestinal surgery may be treated conservatively or surgically, and treatment by lymphatic interventional radiology has also recently come into use. From pedal lymphangiography, intranodal lymphangiography was widely adopted, enabling the site of lymphorrhea to be identified and its approach to be planned, and embolization for lymphorrhea is now becoming feasible in an increasing number of patients. Even for patients in whom embolization is infeasible, identifying the site of leakage and providing the surgeon with this information is useful. Although this technique is still under development, interventional radiologists are now able to play a role in the treatment of lymphorrhea. Herein, we discuss lymphatic interventional radiology for lymphorrhea following gastrointestinal surgery.

Lymphatic Interventional Radiology for Postoperative Lymphatic Leakage

“…13 However, accessing axillary, cervical, para-aortic, or mesenteric lymph nodes is feasible alternative if lymph nodes can be punctured. 3 Local anesthesia of the puncture site using 1% lidocaine is administered. The inguinal or femoral lymph node is then punctured using a 23-gauge Cathelin needle (Terumo Europe, Leuven, Belgium), which is preconnected to a short connector and a small syringe filled with lipiodol, under ultrasound guidance with a high-frequency linear probe.…”

“…Lipiodol injection should be intermittently observed by fluoroscopy to monitor that the needle has not slipped out of the lymph node, which may cause largevolume lipiodol leakage into the surrounding soft tissues or into the vein. 3 A previous review revealed that the technical success of these lymphangiography procedures was achieved in 95.1% (387/407) of the patients who underwent pedal (361: 88.7%) and intranodal lymphangiographies (46: 11.3%). Other patients (20: 4.9%) encountered technical failures, with unsuccessful pedal lymphatic vessel cannulation as the main cause.…”

“…Second, lipiodol acts as an embolizing substance. 3,7 The clinical success rate for lymphatic leakage after conservative treatment was 51 to 89%. 6,7,16 The investigation of 43 patients with various types of lymphatic leakage indicated that lymphatic leakage could be completely stopped in 70% of patients when the lymphatic drainage volume was 500 mL/day.…”

“…4 However, surgical management may be difficult due to postoperative adhesion and poor nutritional condition. 3 Lymphangiography is a useful method for detecting various types of lymphatic leakage, including chylothorax, chylous ascites, and lymphatic fistulae. 5 Previous studies reported the detection rate of leakage points at 64 to 78%.…”

“…5,9,10 This technique remains underdeveloped, but interventional radiologists play a crucial role in treating lymphatic leakage. 3 This study reviews the current status of lymphatic interventional radiology for postoperative lymphatic leakage.…”