Retroperitoneal Lymphocele Research Articles

New technique of En bloc vertebral resection in the thoracolumbar region assisted by retroperitoneal laparoscopy in a single prone position: first results.

To describe the technique and review the oncological and surgical results of the En Bloc resection assisted by retroperitoneal laparoscopy in a single prone position for tumors in the thoracolumbar region. Monocentric retrospective case study. Procedure was performed in a single prone position by a dual team of spine and thoracovascular surgeons. An endoscopic balloon was inflated in the right retroperitoneal cavity. A plan was developed between the anterior spine and vena cava as well as abdominal aorta with segmental vessels ligation. Structures at risk were safely protected under endoscopy during horizontal or sagittal osteotomies. From 2021, seven patients aged a median 52years old (range, 34-67) were included. Involved spinal segments went from T11 to L3. Surgery was aborted in one case due to massive bleeding and ventilating difficulties. There were two partial and four total vertebral resections. Median operating duration and estimated blood loss were 405min (range, 360-540) and 2.1 L (range, 1.2-19), respectively. Postoperative complications consisted of 1 urinary infection; 1 transient urinary retention; 1 posterior wound infection; 1 pneumothorax; 1 persistent partial motor deficit; 1 transient confusion; 1 pulmonary embolism; 1 CSF leak; 1 subdural hematoma; 1 retroperitoneal lymphocele. All margins were uncontaminated. All patients were alive and ambulatory at last follow-up. Early results suggest En Bloc resection assisted by retroperitoneal videoscopy in tumors from T11 to L3/4 disk space is feasible, less invasive and safe. Careful surgical planning and experience in endoscopic vascular surgery are mandatory.

Percutaneous Lymphatic Embolization as Primary Management of Pelvic and Retroperitoneal Iatrogenic Lymphoceles

PurposeTo evaluate the efficacy of lymphatic embolization (LE) in decreasing catheter output and dwell time in iatrogenic lymphoceles after percutaneous catheter drainage. Materials and MethodsRetrospective review of patients who underwent intranodal lymphangiography (INL) with or without LE for management of iatrogenic lymphoceles between January 2017 and November 2020 was performed. Twenty consecutive patients (16 men and 4 women; median age, 60.5 years) underwent a total of 22 INLs and 18 LEs for 15 pelvic and 5 retroperitoneal lymphoceles. Lymphatic leaks were identified in 19/22 (86.4%) of the INLs. Three patients underwent INL only because a leak was not identified or was identified into an asymptomatic lymphocele. One patient underwent repeat INL and LE after persistent high catheter output, and 1 patient underwent repeat INL with LE after the initial INL did not identify a leak. Catheter output was assessed until catheter removal, and changes in output before and after the procedure were reported. The patients were followed up for 2–30 months, and procedural complications were reported. ResultsThe median catheter output before the procedure was 210 mL/day (50–1,200 mL/day), which decreased to a median of 20 mL/day (0–520 mL/day) 3 days after the procedure, with a median output decrease of 160 mL (0–900 mL). The median time between INL with LE and catheter removal was 6 days, with no recurrence requiring redrainage. Four patients experienced minor complications of low-grade fever (n = 2) and lower limb edema (n = 2). ConclusionsLymphangiogram and LE are safe and effective methods for the management of lymphoceles.

Therapeutic and diagnostic algorithm for the treatment of lymphocele in renal transplant recipients

Relevance. Retroperitoneal lymphocele is one of the most common complications in renal transplant recipients.Objective. To improve the results of treatment of kidney transplant recipients with retroperitoneal lymphocele by using a modern diagnostic and treatment algorithmMaterials and methods. Materials and methods: From June 2018 to March 2021 at the State Clinical Hospital named after S.P. Botkin, Moscow performed 174 kidney transplants from a posthumous donor. The accumulation of lymph in the retroperitoneal space was recorded in 24 patients, which amounted to 13.7%. Indications for surgical correction were found in 16 patients, which amounted to 9.1%. Computed tomography in 10 patients (62.5%) showed a wide adherence of the lymphocele cavity to the parietal peritoneum; peritoneum, the complexity of the planned laparoscopic surgery was assessed as high. These patients underwent laparoscopic peritoneal fenestration with ultrasound navigation. In 2 patients (12.5%), lymphocele adherence to the peritoneum was not revealed; these patients underwent open surgery.Results. Results: No relapses of lymphocele were detected after surgery. Mortality was not recorded. In the group of patients who underwent laparoscopic peritoneal fenestration with predictable low complexity, one postoperative complication was diagnosed – migration of the loop of the small intestine into the lymphocele cavity with subsequent infringement. The duration of hospitalization with laparoscopic intervention was 2.1 ± 0.43 (2–3) days, with open one it was 8.45 ± 3.25 (7–12) (p = 0.001).Conclusion. The use of a modern diagnostic and treatment algorithm can improve the results of treatment of kidney transplant recipients with retroperitoneal lymphocele.

Lymphaticovenular anastomosis for lymph vessel injury in the pelvis and groin.

Lymphatic diseases due to lymph vessel injuries in the pelvis and groin require immediate clinical attention when conventional treatments fail. We aimed to clarify the effectiveness of and indications for lymphaticovenular anastomosis (LVA) to treat these lymphatic diseases. We retrospectively evaluated six patients who underwent LVA for lymphatic diseases due to lymph vessel injuries in the pelvis and groin. Specific pathologies included groin lymphorrhea (N = 3), chylous ascites (N = 2), and retroperitoneal lymphocele (N = 1). The maximum lymphatic fluid leakage volume was 150-2600 mL daily. Conventional treatments (compression, drainage, fasting, somatostatin administration, negative pressure wound therapy, or lymph vessel ligation) had failed to control leakage in all cases. We performed lower extremity LVAs after confirming the site of lymph vessel injury using lymphoscintigraphy. We preferentially placed LVAs in thigh sites that showed a linear pattern by indocyanine green lymphography. Postoperative lymphatic fluid leakage volume reduction was evaluated, and leakage cessation was recorded when the drainage volume approached 0 mL. LVA was performed at an average of 4.3 sites (range, 3-6 sites) in the thigh and 2.7 sites (range, 0-6 sites) in the lower leg. Lymphatic fluid leakage ceased in all cases after a mean of 6 days (range, 1-11 days) postoperatively. No recurrence of symptoms was observed during an average follow-up of 2.9 (range, 0.5-5.5) years. LVA demonstrates excellent and rapid effects. We recommend lower extremity LVA for the treatment of lymphatic diseases due to lymph vessel injuries in the pelvis and groin.

Botkin Hospital Transplant Program: 100 solid organ transplantations

Objective : to evaluate the first results of the Botkin Hospital transplant program. Materials and methods . From June 2018 to October 2019, 100 solid organ transplants were performed at the Botkin City Clinical Hospital. Out of the 100 transplantations, 72 were kidney transplants (average age of recipients was 45.65 ± 11.35 years, HLA match averaged 2.09 ± 1.03) and 28 were liver transplants (average age of recipients was 50.14 ± 7.62 years, average MELD was 17.78 ± 3.28 (14–34). Results . After transplantation, there was no 30-day mortality. Postoperative complications following kidney transplantation were established in 11 patients (15.2%). In 3 patients (4.3%) – suppuration of postoperative wound, in 2 patients (2.8%) – hematomas in the area of the postoperative suture during hemodialysis, in 5 patients (6.9%) – retroperitoneal lymphocele, in 1 patient (1.4%) – urosepsis. There were 4 cases (5.5%) of acute rejection, 3 cases (4.2%) of humoral rejection, and 1 case (1.3%) of cellular rejection. Early postoperative complications following liver transplantation were detected in 2 patients (7.2%). In one patient – hematoma under the right lobe of the liver on the 1st day after surgery, the diaphragm was the source of bleeding, in one patient – ascites leakage through postoperative sutures, which required relaparotomy. In 2 patients (7.2%), postoperative complications were found in the separated postoperative period. In one case, of choledochocholedochal anastomotic stricture – stricture stenting was performed with coated nitinol stent. In another case, acute adhesive intestinal obstruction, which required laparotomy, adhesiolysis. Conclusion . Implementation of the transplantation program in multidisciplinary hospitals can boost transplant care in a district and improve the treatment results of patients with terminal organ damage.

Retroperitoneal Lymphocele in a Patient with Primary Ovarian Cancer: A Case Report

Retroperitoneal Lymphocele in a Patient with Primary Ovarian Cancer: A Case Report

Massive Ascites in a Renal Transplant Patient after Laparoscopic Fenestration of a Lymphocele.

Retroperitoneal lymphocele is a common complication of renal transplantation. Here, we report the case of a 67-year-old woman with massive ascites after fenestration surgery for a lymphocele that developed following renal transplantation. She had been on continuous ambulatory peritoneal dialysis for 9 years. Living donor renal transplantation was performed and an intrapelvic lymphocele subsequently developed. The lymphocele did not resolve after aspiration therapy; therefore, laparoscopic fenestration was performed. Although the lymphocele disappeared, massive ascites appeared in its stead. Half a year later, the ascites was surgically punctured, which then gradually resolved and disappeared 6 weeks later. Aspiration therapy should be considered in patients on long-term peritoneal dialysis, although laparoscopic fenestration is safe and effective.

Retroperitoneal lymphocele after lumbar total disc replacement: a case report and review of literature

Background Retroperitoneal lymphoceles (RPLs) caused by injury to the lymphatics are commonly seen after pelvic lymphadenectomy, renal transplantation, and gynecologic tumor resection surgeries. Degenerative disc disease still remains the major cause of low-back pain. Anterior lumbar spinal procedures, such as anterior lumbar interbody fusion and anterior lumbar arthroplasty, have been increasingly performed for treatment of axial back pain. RPLs, as an approach-related complication, though infrequent, have been reported after anterior lumbar spinal surgery. We report a case of RPL after total disc replacement of the lumbar spine. To our knowledge, there has been no prior report of RPL after total disc replacement managed by percutaneous aspiration only. Methods A 49-year-old woman who underwent total disc replacement at the L4-5 level presented with a postoperative complication of RPL. The imaging findings, clinical course, and treatment are discussed, and a review of literature is presented. Results The patient presented with significant abdominal swelling and discomfort at 4 weeks after surgery without any signs or symptoms of infection. Investigations showed an RPL. She was treated by multiple aspirations under ultrasound guidance. At 12 months' follow-up, the patient had no further abdominal symptoms and had gone back to her routine activities and work with significant improvement in back pain. Conclusions RPL is an uncommon complication after anterior lumbar surgery and can be managed effectively if detected and diagnosed early. Although repeated aspiration is associated with high recurrence and infection, it is a safe and minimally invasive procedure to manage RPL.

Retroperitoneal Lymphatic Cyst Formation After Anterior Lumbar Interbody Fusion

Case report. A retroperitoneal lymphocele is a very rare complication associated with anterior lumbar interbody fusion surgery. We report the diagnosis and management of 3 retroperitoneal lymphoceles, which occurred after anterior left retroperitoneal approaches for lumbar interbody fusion. As the radiologic examinations revealed the lymphoceles in all 3 cases laparoscopic fenestration was performed. The patients had good recovery and no recurrence of the lymphoceles occurred. If this rare complication occurs the primary intervention should be laparoscopic fenestration because of the high recurrence rate of other treatment modalities.

Retroperitoneal Lymphocele After Anterior Spinal Surgery

Case report; Review of Literature. To present an uncommon complication after anterior lumbar surgery as well as a treatment option and a review of the literature. A number of complications have been reported after anterior lumbar surgery. Common complications include vascular, ureteral, and neurologic injuries. The development of a retroperitoneal lymphocele has been previously been described, but details regarding evaluation, diagnosis, and treatment options are lacking in the literature. The case of a single patient with a postoperative retroperitoneal lymphocele was identified and retrospectively reviewed. Permission was obtained from the patient to review and publish this information. A review of literature on lymphoceles and anterior lumbar complications was also performed using PubMed and Ovid databases. A 76-year-old woman underwent anterior interbody fusion from L2-L3-L4-L5, followed by posterior T11-L5 fusion for degenerative scoliosis and spinal stenosis. Six weeks after surgery, she presented with severe abdominal pain, nausea, and emesis. Examination revealed a retroperitoneal lymphocele, which was confirmed after aspiration. The patient was treated with a laparoscopic marsupialization procedure without recurrence. At 12 months, the patient had no further abdominal symptoms, noted improvements in back and leg pain scores, and had stable radiographic findings. Retroperitoneal lymphocele is a rare complication after anterior lumbar interbody fusion. The different diagnosis should include infectious abscess, ureteral injury with urinoma, pancreatic injury with pseudocyst formation, and spinal fluid leak with pseudomeningocele. Diagnosis can be guided by serum and cyst fluid analysis. Although treatment options exist, surgical treatment may provide the most reliable results.

Laparoscopic Marsupialization of Pelvic Lymphocele under Transvaginal Ultrasonographic Guidance

Lymphocyst formation is a common complication of pelvic lymphadenectomy. We treated a 54-year-old woman with lymphocele by laparoscopic marsupialization. She developed hydronephrosis as a result of retroperitoneal lymphocele after total abdominal hysterectomy and pelvic lymphadenectomy for endometrial cancer. Laparoscopic marsupialization under transvaginal ultrasonographic guidance was chosen because conservative therapy including percutaneous or transvaginal drainage ran the risk of bowel perforation. The 6-cm collection was opened and its edges were coagulated electrosurgically and sutured with the surrounding peritoneum. The postoperative course was satisfactory, and hydronephrosis was resolved. This highly effective minimally invasive procedure was beneficial to the patient.

Laparoscopic marsupialisation of pelvic lymphocysts following total abdominal hysterectomy and pelvic lymphadenectomy for endometrial cancer: A case report

Lymphocele formation, a common complication of pelvic lymphadenectomy, can produce considerable morbidity. Treatment is sometimes problematic. We treated a 54-year-old woman with a symptomatic lymphocele by laparoscopic marspialization.She developed hydronephrosis due to a retroperitoneal lymphocele following total abdominal hysterectomy and pelvic lymphadenectomy for endometrial cancer. Because conservative therapy, including percutaneous or transvaginal drainage, had a risk of bowel perforation, we chose laparoscopic marsupialisation under transvaginal ultrasonographic guidance. The 6-cm collection was opened, and the edges were cauterized and sutured with the surrounding peritoneum. The postoperative course was satisfactory and the hydronephosis resolved. This highly effective, minimally invasive procedure offers a significant advantage to the patient.

Access strategies for revision or explantation of the Charité lumbar artificial disc replacement

Several lumbar disc prostheses are being developed with the goal of preserving mobility in patients with degenerative disc disease. The disadvantage of lumbar artificial disc replacement (ADR) compared with anterior interbody fusion (ALIF) is the increased potential for displacement or component failure. Revision or removal of the device is complicated by adherence of the aorta, iliac vessels, and the ureter to the operative site. Because of these risks of anterior lumbar procedures, vascular surgeons usually provide access to the spine. We report our experience with secondary exposure of the lumbar spine for revision or explantation of the Charité disc prosthesis. Between January 2001 and May 2006, 19 patients with prior implantation of Charité Artificial Discs required 21 operations for repositioning or removal of the device. Two patients had staged removal of prostheses at two levels. One patient had simultaneous explantation at two levels. The mean age was 49 years (range, 31 to 69 years; 56% men, 42% women). The initial ADR was performed at our institution in 14 patients (74%). The mean time from implantation to reoperation was 7 months (range, 9 days to 4 years). The levels of failure were L3-4 in one, L4-5 in nine, and L5-S1 in 12. The ADR was successfully removed or revised in all patients that underwent reoperation. Three of the 12 procedures at L5-S1 were performed through the same retroperitoneal approach as the initial access. One of these three, performed after a 3-week interval, was converted to a transperitoneal approach because of adhesions. The rest of the L5-S1 prostheses were exposed from a contralateral retroperitoneal approach. Four of the L4-5 prostheses were accessed from the original approach and five from a lateral, transpsoas exposure (four left, one right). The only explantation at L3-4 was from a left lateral transpsoas approach. Nineteen of the 22 ADR were converted to ALIF. Two revisions at L5-S1 involved replacement of the entire prosthesis. One revision at L4-5 required only repositioning of an endplate. Access-related complications included, in one patient each, iliac vein injury, temporary retrograde ejaculation, small-bowel obstruction requiring lysis, and symptomatic, large retroperitoneal lymphocele. There were no permanent neurologic deficits, deep vein thromboses, or deaths. Owing to vascular and ureteral fixation, anterior exposure of the lumbar spine for revision or explantation of the Charité disc replacement should be performed through an alternative approach unless the procedure is performed < or = 2 weeks of the index procedure. The L5-S1 level can be accessed through the contralateral retroperitoneum. Reoperation at L3-4 and L4-5 usually requires explantation and fusion that is best accomplished by way of a lateral transpsoas exposure.

Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy: Prospective multicenter study of 100 patients with early cervical cancer

Objective. The aim of this prospective clinical multicenter study “Uterus 6” of the German Association of Gynecologic Oncologists (AGO) was to prove the recurrence rate of patients treated with pelvic lymphadenectomy and radical vaginal trachelectomy (RVT). We also wanted to prove the surgical safety of RVT. Methods. Between March 1995 and November 2005, we intend to treat 108 patients with cervical cancer (TNM stage 1A1, L1 n = 18, 1A2 n = 21, 1B1 n = 69) by RVT. Eight patients were excluded since the study criteria were not met after RVT (tumor size >2 cm, neuroendocrine tumor type, tumor-involved resection margins, or positive pelvic lymph nodes). Thus, 100 patients were treated by RVT according to protocol. With 4 recurrences in a sample size of 100 patients, an upper limit of the 95% confidence interval (including continuity correction) of 10.5% was calculated. Recruitment had to be stopped if five or more recurrences occurred. Results. The median follow-up time was 29 (1–128) months. Three (3%) recurrences occurred in 100 patients treated with RVT according to protocol. Thus, the upper confidence limit was 9.2%. The projected 5-year recurrence-free and overall survival rates were 97% and 98%. The average duration of surgery was 253 (115–402) min. Perioperative complications were: postoperative bleeding, embolism of the external iliac artery, retroperitoneal lymphocele, or paralytic ileus in one patient, respectively. Conclusions. RVT combined with laparoscopic pelvic and parametric lymphadenectomy for treatment of patients with early stage cervical cancer ≤2 cm results in a recurrence-free survival of more than 90.8%.

Primary retroperitoneal lymphocele in a pregnant woman: The first report

In a 32-year-old pregnant woman, routine ultrasonography revealed right hydronephrosis and a huge retroperitoneal mass (20 x 7 cm) containing a fluid collection. Percutaneous drainage of the mass was performed and 2 L of clear, yellowish fluid was collected. Four months following the delivery, a recurrent retroperitoneal lymphocele was identified. Six months after the delivery, laparoscopic marsupialization was performed through a 10-mm umbilical camera port and two 5-mm ports on the right side of the abdomen. A posterior peritoneal window was established by creating a wide opening in the anterior wall of the lymphocele. Subsequent ultrasonography did not indicate a recurrence of the lymphocele or right hydronephrosis over a follow-up period of 8 months.

Retroperitoneal laparoscopic management of a lymphocele after abdominal aortic surgery: A case report

A retroperitoneal lymphocele is a rare complication of abdominal aortic surgery. We present a case of 77-year-old man who developed a retroperitoneal lymphocele 14 days after undergoing graft replacement for an abdominal aortic aneurysm. Paracentesis showed a white and turbid fluid that was determined to be chyle. Conservative therapy, including percutaneous drainage, fasting, and total parenteral nutrition, was unsuccessful. Retroperitoneal laparoscopic ligation of the leaking lymphatics was performed on postoperative day 33. The postoperative course was satisfactory. The laparoscopic approach to retroperitoneal lymphocele treatment after abdominal aortic repair is a safe and minimally invasive therapeutic method.

Retroperitoneal lymphocele associated with lumbar spine fracture: report of an unusual case

To describe a case of retroperitoneal lymphocele as an extremely rare complication after lumbar spine fracture. To discuss the possible mechanism of development of retroperitoneal lymphocele following blunt trauma to the ureter and lumbar spine. Fukui University Hospital, Fukui, Japan. A 71-year-old man presented with severe intractable low back pain caused by a huge retroperitoneal lymphocele, which was considered to be related to an occult L4 vertebral fracture and a blunt ureteral injury. The retroperitoneal lymphocele also caused significant instability at L3-4 level, thus requiring surgical resection followed by interbody fusion. Physicians should be aware that such unusual retroperitoneal lymphocele might develop even after a blunt ureteral injury or a minor lumbar spine fracture.

腹部大動脈置換術後の後腹膜腔乳び貯留に対するリンパ管結さつ術の１治験例

腹部大動脈置換術後の後腹膜腔乳び貯留に対するリンパ管結さつ術の１治験例

Radiotherapy of lymphatic fistula and lymphocele

The treatment of persistent postoperative lymphatic fistulas or lymphoceles is often a problem. Approximately 2% of patients will develop lymphatic fistula after vascular surgery. This can require a long lasting conservative therapy. If spontaneous cure fails, a second operation with wound revision becomes necessary. We studied low-dose percutaneous radiotherapy to be used as an alternative treatment in addition to conservative or surgical therapy. Between 1989 and 1998 29 patients (25 with lymphatic fistulas, 4 with lymphoceles) received radiation therapy. Depending on the depth of the fistula 27 patients were treated with electrons (7 to 18 MeV). Two other patients suffering of retroperitoneal lymphoceles received a treatment with photons (15 MV). In all patients the fractionation was 4- to 5 x 1.0 Gy/week and the dose ranged from 3 to 12 Gy depending upon the onset of the radiation therapy effect. In 27 of 28 evaluable patients a complete disappearance of the fistula or lymphocele was achieved by radiation during therapy or shortly afterwards. In 1 case no benefit was observed after a dose of 11 Gy. This patient required further surgery with wound exploration. Low dose percutaneous radiotherapy (up to 10 to 12 Gy) is effective to heal lymphatic fistulas and lymphoceles without complications. Individual dosage is required because doses even lower than 10 Gy may be effective. Radiation can be effective even after a failed conservative therapy or instead of surgery.

LAPAROSCOPIC MARSUPIALIZATION OF A LARGE RETROPERITONEAL LYMPHOCELE

A 19-year-old man presented with a palpable abdominal mass, left supraclavicular adenopathy and intratesticular swelling of the left testis on ultrasound. Fine needle aspiration of the supraclavicular nodes revealed embryonal carcinoma. Serum a-fetoprotein and b human chorionic gonadotropin levels were elevated at 20 and 168 m./dl., respectively. The patient received 4 courses of combination chemotherapy with bleomycin, etoposide and cisplatin. Serum markers became normal (a-fetoprotein 3.6 and b human chorionic gonadotropin less than 2 m./dl.) and all metastatic lesions disappeared. The 4 3 4 3 4.5 cm. area of retroperitoneal swelling that remained was excised at left orchiectomy. Only necrotic tissue with no viable tumor was identified in both specimens. The patient complained of abdominal ache with fullness, anorexia and weight loss 2 years later. Computerized tomography (CT) of the abdomen revealed a large retroperitoneal lymphocele extending into the pelvis (fig. 1, A). Laparoscopic marsupialization was performed through a 10 mm. umbilical camera port and 2, 5 mm. ports on the right side of the abdomen. After opening the anterior wall of the lymphocele 5 l. fluid were drained. A large posterior peritoneal window was established by widely opening the anterior cyst wall (fig. 2). Abdominal CT 4 months postoperatively showed a small residual lymphocele in the upper retroperitoneum with no recurrence of the marsupialized lymphocele (fig. 1, B). DISCUSSION