Minimally Invasive Treatment of Abdominal Lymphocele: A Review of Contemporary Options and How to Approach Them

Abstract

Lymphoceles are lymphatic fluid collections resulting from lymphatic vessel disruption after surgery or trauma. They are most often described following retroperitoneal surgeries such as cystectomies, prostatectomies, renal transplants, and gynecologic surgeries. Most lymphoceles are asymptomatic and resolve spontaneously without treatment. If persistent, they can become infected or exert mass effect on adjacent structures causing pain, urinary, or lower limb edema particularly for lymphoceles in the pelvis Symptomatic lymphoceles should be treated to relieve symptoms and prevent functional compromise of vital adjacent structures. Although surgery has been traditionally accepted as the gold standard treatment, advances in imaging and interventional technology allow for less invasive, percutaneous treatment. Available minimally invasive treatment options include percutaneous aspiration, catheter drainage, sclerotherapy, and lymphangiography with lymphatic embolization. A review of these treatment options and a suggested algorithm for managing lymphoceles is presented.

Technical Outcome, Clinical Success, and Complications of Low-Milliampere Computed Tomography Fluoroscopy-Guided Drainage of Lymphoceles Following Radical Prostatectomy with Pelvic Lymph Node Dissection

“…Lymphoceles are collections of leaked lymphatic fluid with no distinct epithelial lining [ 1 , 2 , 3 , 4 ]. They commonly occur after surgical procedures which involve resection in areas with extensive lymphatic networks, causing disruption of lymph vessels, such as following radical prostatectomy (RP), perineal resections for genitourinary malignancies, vascular bypass surgery, renal transplantation and axillary lymph node dissection (LND) [ 1 , 4 , 5 , 6 ]. Lymphoceles are the most frequent non-functional complication of (RP) with pelvic lymph node dissection and were identified in up to 26% of patients post-RP in a study by Khoder et al [ 7 , 8 ].…”

“…There is no consensus on the optimal treatment for post-operative lymphoceles after RP [ 1 ]. Treatment options include percutaneous fine-needle aspiration, percutaneous catheter drainage, sclerotherapy, embolization during lymphangiography, and open or laparoscopic surgical evacuation with marsupialization [ 1 , 4 , 5 , 6 , 7 , 12 , 13 ]. Percutaneous catheter drainage +/− instillation of a sclerosing agent and laparoscopic fenestration are the most commonly performed therapeutic procedures.…”

Lymphorrhea following Tunneled Femoral Central Venous Catheter Placement: Avoidance and Management of a Rare Complication

“…For instance, a peripheral lymphatic injury will have odorless, clear, and thin fluid; have lymphocyte predominance; and occur within hours to days of the procedure. 14 In contradistinction, infectious drainage is turbid, malodorous, neutrophil predominant, and occurs 7 to 14 days later. Peripheral lymphatic injury resulting in lymphorrhea can be managed equivalently to a ruptured lymphocele.…”

“…Peripheral lymphatic injury resulting in lymphorrhea can be managed equivalently to a ruptured lymphocele. 14 Conservative treatment can include watchful waiting and local pressure if the leak is not robust or bothersome to the patient. However, if the leak is not improving, has features of infection, or if the patient is decompensating, then a more aggressive approach is warranted.…”

Back to the Future II—A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions

“…Indwelling drainage catheters are monitored for daily drainage volume and can be removed when the volume decreases to only a few milliliters per day. This, however, may take several weeks or even months 130,190 . Therefore, sclerotherapy is an alternative and/or adjunct to continuous drainage therapy 190 .…”