Sclerotherapy Group Research Articles

Therapeutic effects of endoscopic foam sclerotherapy for bleeding internal hemorrhoids

Objective To evaluate the safety and efficacy of foam sclerotherapy for bleeding internal hemorrhoids. Methods Consecutive adult patients (aged 18-60 years) with bleeding hemorrhoids were prospectively enrolled between March 2017 and March 2018. All patients were randomly assigned to the foam sclerotherapy (FS) group and the liquid sclerotherapy (LS) group. The foam and liquid sclerotherapy of hemorrhoids nucleus was performed by cap-assisted colonic endoscopy. Results A total of 108 patients were enrolled, including 62 males (57.4%) with mean age of 44.0±7.6 years. There was no significant difference in gender, age, or body mass index between the FS (n = 55) group and the LS (n =53) group. The total amount of lauromacrogol injection in the FS group was 3.7±0.9 mL, which was significantly lower than that in the LS group (8.0±2.2 mL, P<0.001). In the LS group, 8 patients (15.1%) developed bleeding after needle removal, which was significantly higher than that in the FS group [5.5%(3/53), P=0.022]. Significant pain was found in 2 patients (3.8%) in the LS group and 0 in the FS group (P= 0.025). The short-term cure rate and effective rate of the FS group were 87.3% (48/55) and 9.1% (5/55), while those were 69.8% (37/53) and 22.6% (12/53) in the LS group, respectively (P=0.046). Conclusion Foam sclerotherapy is safe and effective in the treatment of bleeding internal hemorrhoids. Key words: Hemorrhoids; Sclerosing solutions; Hemostasis, endoscopic; Sclerotherapy

Comparison of foam sclerotherapy versus radiofrequency ablation in the treatment of primary varicose veins due to incompetent great saphenous vein: Randomized clinical trial

Minimally invasive procedures such as foam sclerotherapy and radiofrequency ablation (RFA) have gained attention for treatment of incompetent great saphenous vein (GSV). The objective of this study was to compare recurrence rate and quality of life between foam sclerotherapy and RFA in patients with incompetent GSV varicose veins. In this parallel single-blinded randomized clinical trial, 60 adult patients with primary varicose veins due to incompetent GSV (CEAP classes C2-4EPAsPr) were included and randomly divided to receive RFA or foam sclerotherapy. Health-related quality of life (HRQOL) was assessed by the Short Form 36, and the Aberdeen Varicose Vein Questionnaire (AVVQ) was applied to assess the impact of varicose veins on quality of life of the patients. In addition, pain severity after the procedures was investigated by a visual analog scale (VAS) (range, 0 to 10). The patients were followed at 1week, 1month, 3months, and 6 months postoperation. GSV reflux and recurrence was assessed by color Doppler ultrasound examination after 6 months. Twenty-eight patients in RFA and 27 patients in foam sclerotherapy remained for the final analyses. The time interval from the procedure and recovery to daily normal activities was 1 day in both groups. Mean (±SD) pain VAS score in RFA group decreased from preintervention score of 7.35 (±3.28) to 1.21 (±0.68); P<.0001. Likewise, this score decreased from 6.64 (±2.04) to 1.29 (±0.91) in foam sclerotherapy group. HRQOL scores increased gradually at 1, 3, and 6months after the intervention. AVVQ scores decreased significantly 1 week postintervention in both groups. After 6 months, 17.9% (5 patients) in RFA group and 14.8% (4 patients) in foam sclerotherapy group had recurrence of GSV reflux (P=.52). Both foam sclerotherapy and RFA were effective in treatment of GSV reflux. Comparable findings were observed between the 2 groups regarding postoperative pain, recovery time, HRQOL, and AVVQ scores.

Safety and efficacy of surgery combined with bleomycin irrigation for complex cervical–facial lymphatic malformations of children

BackgroundIn this retrospective study, we compare the safety and efficacy of surgery combined with bleomycin intra-operatively with intralesional sclerotherapy alone for the management of head and neck lymphatic malformations in children. Materials and methodsThe patients with cervical–facial lymphatic malformations were reviewed in Shanghai Children's Hospital from August 2014 to August 2018. Data analysis was performed using SPSS17.0. Pearson X2 test and t-test were used, and the significance level was fixed at 5%. Results72 patients in all of which 63 patients underwent surgical excision combined with bleomycin irrigation and 9 patients underwent sclerotherapy alone as the primary treatment. The surgical excision group had a significantly higher rate of an excellent response compare to the sclerotherapy group (P < 0.05). In regards to postoperative complications, the surgical group had no higher rate of temporal facial paralysis and other nerve injures compare to the sclerotherapy group (P = 0.624). Conclusionswe recommend surgery combined with Bleomycin for microcystic disease with focal and less infiltrative lesions and for lesions located in the oropharynx, parapharynx, retropharynx, or hypopharynx.

Comparative Study of Postoperative Complications after Rubber Band Ligation (RBL) and RBL Combined with Sclerotherapy in Treatment of Second- and Third-Degree Internal Hemorrhoids

Hemorrhoid is a very common disease in surgical departments. Internal hemorrhoids of second degree or above often require surgical treatment due to the persistent bleeding and prolapse symptoms. Rubber band ligation (RBL) is the most common procedure available for hemorrhoids because of its safety, efficacy, and effectiveness. The study evaluates comparative results of postoperative complications after RBL and RBL combined with sclerotherapy. It included 300 patients having second- or third-degree internal hemorrhoids who attended the colorectal surgical department in Beilun People’s Hospital of Ningbo, China, over a period of 1 year from July 2015 to June 2016. These 300 patients were selected randomly and divided into two groups, with 150 for RBL group and 150 for RBL combined with sclerotherapy group. All the patients were asked to return to an out-patient clinic for follow-up at 1 day, 3 days, 7 days, 14 days, 2 months, and 6 months and through a telephone call every 6 months for 2 years. The data of all the patients including gender, age, postoperative pain, postoperative bleeding, the days of rubber band slippage, and postoperative recurrence were recorded. The statistical analysis of the study was done using SPSS statistical package in which we used descriptive statistics and chi-square test for the final evaluation. There was no significant difference between the two groups in postoperative pain. However, RBL combined with sclerotherapy achieves better results than RBL, less postoperative bleeding, less unexpected rubber band slippage, and less postoperative recurrence.

A comparative study of sclerotherapy and rubber band ligation versus open hemorrhoidectomy in second degree hemorrhoids

Background: Hemorrhoids affects the quality of life and leads to significant pain and discomfort. The current study was done to evaluate the results of comparative treatment of rubber band ligation, sclerotherapy and open hemorrhoidectomy.Methods: This was a prospective study done on 90 patients with second grade internal hemorrhoids attended to the Department of General Surgery at S. Nijalingappa Medical and Research Centre, Bagalkot during the study period from 2012 November to 2013 December. Systemic examination and basic investigations were done. According to severity and type of symptoms, patients are subjected for open hemorrhoidectomy (n=30), banding (n=30) and sclerotherapy (n=30).Results: Occurrence of hemorrhoids was seen between the age group of 36 to 45 years. Out of 90 patients 52 were males and 38 were females. Common presenting complaint was bleeding per rectum and mass per rectum in 33.33% of patients. Postoperative hospital stay was 1 day in the groups treated with rubber band ligation and sclerotherapy and in open hemorrhoidectomy 28 patients stayed for 3 days and 2 patients for 5 days. About 70% of patients belonging to rubber band ligation and sclerotherapy group gave excellent response to the same.Conclusions: In our study, rubber band ligation technique was found to be more cost effective and reliable to treat second grade hemorrhoids with lesser postoperative complications followed by sclerotherapy and hemorrhoidectomy.

Endoscopic injection sclerotherapy versus N-Butyl-2 Cyanoacrylate injection in the management of actively bleeding esophageal varices: a randomized controlled trial

BackgroundThe management of acute esophageal variceal bleeding remains a clinical challenge. Band ligation is the main therapeutic option, but it may be technically difficult to perform in active bleeders. This may necessitate an alternative therapy for this group of patients. This study was conducted to assess the safety and efficacy of sclerotherapy versus cyanoacrylate injection for management of actively bleeding esophageal varices in cirrhotic patients.MethodsThis prospective study included 113 cirrhotic patients with actively bleeding esophageal varices. They were randomly treated by endoscopic sclerotherapy or cyanoacrylate injection as banding was not suitable for those patients due to profuse bleeding making unclear endoscopic visual field. Primary outcome was incidence of active bleeding control and secondary outcomes were incidence of six weeks rebleeding, complications, and mortality among the studied patients.ResultsInitial bleeding control was significantly higher in cyanoacrylate versus sclerotherapy groups (98.25, 83.93% respectively, P = 0.007). No significant differences between sclerotherapy and cyanoacrylate groups regarding rebleeding (26.79, 19.30% respectively, P = 0.344), complications, hospital stay or mortality rate were observed.ConclusionsBased on this single-center prospective study, both of these therapies appear to have relatively favorable outcomes, although cyanoacrylate injection may be superior to sclerotherapy for initial control of active bleeding.Trial registration[ClinicalTrials.gov Identifier:NCT03388125]–Date of registration: January 2, 2018 “Retrospectively registered”.

The Efficacy of Lymph Node Embolization Using N-Butyl Cyanoacrylate Compared to Ethanol Sclerotherapy in the Management of Symptomatic Lymphorrhea after Pelvic Surgery

PurposeTo compare the efficacy of lymph node (LN) embolization using N-butyl cyanoacrylate versus ethanol sclerotherapy in the management of symptomatic postoperative pelvic lymphorrhea. Materials and MethodsThirty-three patients with 40 instances of symptomatic postoperative lymphorrhea were treated with either LN embolization or sclerotherapy at Seoul National University Hospital from January 2009 to July 2017 and were retrospectively included (LN embolization group: 24 lymphoceles of 19 patients, mean age of 59.29 years; sclerotherapy group: 16 lymphoceles of 14 patients, mean age of 60.95 years). The types of operations were hysterectomy and bilateral oophorectomy with pelvic lymph node dissection (n = 9), radical prostatectomy (n = 3), and renal transplantation (n = 2) for the sclerotherapy group and radical prostatectomy (n = 10) and hysterectomy and bilateral oophorectomy with pelvic lymph node dissection (n = 9) for the LN embolization group. The 3 most common indications of treatment were lower extremity edema (n = 11), pain (n = 11), and fever (n = 8). The amount of leak before treatment (initial daily drainage) and clinical outcomes, including the clinical success rate in 3 weeks, treatment period, and complication rate were compared between both groups. ResultsLN embolization showed a higher 3-week clinical success rate than sclerotherapy in a univariate analysis (83.3% and 43.8%, P = .026). There was no statistically significant difference in the treatment period and the complication rate (7.1 days and 12.3 days, P = .098; 8.3% and 25.0%, P = .184). ConclusionsLN embolization is more effective for treating postoperative pelvic lymphorrhea than sclerotherapy with similar safety.

Evaluation of liquid or foam sclerotherapy in small varicose veins (ceap c1) with venous clinical severity score.

We aimed to evaluate the efficacy of liquid or foam sclerotherapy of varicose veins using venous clinical severity scores and possible complications. A total of 318 patients (268 females, 50 males) who were treated with liquid or foam sclerotherapy between January 2012 and December 2012 were included in this study. Skin necrosis was observed in only 6 patients (1. 8%), thrombophlebitis in 10 patients (3. 1%), and hyperpigmentation in 18 patients (5. 6%) in this study group. The mean venous clinical severity score was calculated as: pain score, 1. 23 ± 0.88; varicose vein score,1.85 ± 0. 8; edema score, 0.64 ± 0.77). Pain and edema decreased at the control examination, 1 month after completion of sclerotherapy sessions. Varicose veins completely disappeared after sclerotherapy. While the decrease in edema in the foam sclerotherapy group was significantly less (P<0.001), the decline in pain showed an increasing trend (P=0.069). While skin necrosis did not develop after foam sclerotherapy, rates of pigmentation and local thrombophlebitis were similar (P>0.05). In conclusion, we observed that both sclerotherapy methods are effective with a low rate of complications, alleviating the complaints of patients with small varicose veins, and providing considerable improvement in venous clinical severity scores.

Comparison of Endoscopic Variceal Ligation with Endoscopic Sclerotherapy for Secondary Prophylaxis of Variceal Hemorrhage: A Randomized Trial.

BackgroundThough endoscopic variceal ligation (EVL) is commonly being used and has overcome the disadvantages of sclerotherapy (ST), still sclerotherapy is used as a therapeutic procedure for bleeding esophageal varices in the present institute. Hence, the study was done to see the advantages of EVL over ST.MethodsPatients with portal hypertension and bleeding esophageal varices underwent banding if found to have grade 3 or 4 varices. They were randomized to EVL group, where they were reviewed after two weeks for any residual varices for which repeat banding was done and endoscopic sclerotherapy (EST) group, where ST was done until the varices were obliterated or reduced to grade 1. The efficacy, complications, recurrent bleeding rate and recurrence of varices were compared.ResultsA total of 60 patients were included, 30 in each group. In EVL group, four sessions were needed to eradicate the varices in 73% of patients while it was five sessions in EST group (46% patients) (p-value = 0.0001). The mean number of sessions needed in EVL and EST group was 3.73 and 5.36, respectively. The average time taken for eradication of varices was 78.6 and 134.6 days in EVL and EST group, respectively (p-value = 0.004). Complications were higher in EST group (p-value < 0.05).ConclusionEVL alone was effective than ST in terms of the number of sessions needed for eradication of varices and total duration required to completely obliterate them. The complications were less in EVL group with no significant difference in recurrent bleeding rate and recurrence of varices between the groups.

Prevention of recurrence of simple renal cyst after retroperitoneal laparoscopic decortication

Objective To investigate the effective method of reducing the recurrence of renal cyst after retroperitoneal laparoscopic decortication. Methods The clinical and follow-up data of 328 cases of patients with simple renal cyst underwent retroperitoneal laparoscopic renal cyst decompression from January 2014 to March 2016 in our hospital were analyzed retrospectively. One hundred and five patients had a simple decortication (control group, n=105). The remaining 223 patients had a decortication with different intervention method to prevent recurrence, including 60 cases with anhydrous ethanol sclerotherapy (sclerotherapy group, n=60), 78 cases with wadding of the cyst using perirenal fat tissue (fat wadding group, n=78 ) and 85 cases with evaginated and fixed the cyst wall by titanium clips (titanium clips fixed group, n=85). The operation time, intraoperative blood loss, postoperative complications, postoperative hospital stay and recurrence rate after 1 year were compared. Results Compared with the control group, all the 3 intervention methods (sclerotherapy group, fat wadding group and titanium clips fixed) significantly decreased the 1 year recurrence rate (5%, 3.8%, 4.7% vs. 13.3%, F=8.319, P=0.040). However, the operation time [(40.7±12.6)min vs. (30.5±10.2)min, t=5.664, P 0.05). Conclusions Combined with wadding of the cyst using perirenal fat tissue or evaginated and fixed the cyst wall by titanium clips in the retroperitoneal laparoscopic decortication is a safe and effective method to reduce postoperative recurrence. The anhydrous ethanol sclerotherapy may be an inappropriate choice due to increased operation time and complications. Key words: Kidney Diseases; Cysts; Laparoscopes; Decompression, Surgical

Abstract No. 429 A case control study of percutaneous sclerotherapy versus transcatheter hepatic arterial embolization for treatment of large-volume hepatic hemangioma

To evaluate the clinical efficacy of percutaneous sclerotherapy and transcatheter hepatic artery embolization in the treatment of large volume hepatic hemangioma. Twenty-two patiens with large-volume hepatic hemangioma (diameter larger than 5 cm) were randomly divided into two groups between Jan 2015 and Aug 2017 at one single institution. Eleven cases were undergone percutaneous injection of bleomycin sclerotherapy under CT-guidance (sclerotherapy group), 11 patients were performed by DSA-guided bleomycin lipiodol emulsion transcatheter hepatic artery embolization (embolization group). The procedure time, hospital cost, postoperative outcomes, complications and QOL scales were reviewed and analyzed. The mean procedure time (15.6+6.4) min in sclerotherapy group was shorter than that in the embolization group (51.5+7.2) min. The liver dysfunction rate of sclerotherapy group (27.3%, 3/11) was much lower than that in embolization group (90.9%, 10/11). The mean hospitalization and cost of sclerotherapy group were significantly less than that of embolization group, p0.05. At 6 months follow-up post procedure, the effective rate (CR+PR) of sclerotherapy group and embolization group were (81.8%, 9/11), (92.3%, 10/11), respectively, p>0.05. Both approaches (sclerotherapy, embolization) in the treatment of large-volume hepatic hemangioma are effective and safe. Sclertotherapy is more simple, cost-effective method in the treatment of hepatic hemangioma.

Outcome of Ultrasonography-Guided Foam Sclerotherapy Versus Stab Avulsion Ambulatory Phlebectomy in the Treatment of Varicosis in Small Veins of the Leg: A Single Blinded Randomized Clinical Trial

Background: In the intervening years, a few randomized clinical trials have confirmed that foam sclerotherapy is effective in managing great vein incompetence. However, no details have been published in its efficacy in comparison with conventional methods such as stab avulsion in the treatment of varicosis in small veins. Objectives: This randomized clinical trial was conducted to compare results and outcomes of the ultrasonography-guided foam sclerotherapy and conventional stab avulsion ambulatory phlebectomy in the treatment of varicosis in small veins of the leg. Patients and Methods: In a randomized single-blinded clinical trial, patients with varicosis in the small veins of the leg were randomly assigned for treatment with ultrasonography-guided foam sclerotherapy (n = 45) or with ambulatory phlebectomy (n = 45). Follow-up visits were done in 1 week, 1 and 6 months after operation and all patients were assessed regarding postoperative pain, need for analgesics, time to return to work, and level of satisfaction. Results: Postoperative pain was significantly lower in foam sclerotherapy group by VAS (P = 0.003). There was a significant difference in the morbidity rate between the two techniques (13.3%. in foam sclerotherapy, 37.8% in ambulatory phlebectomy, P = 0.008). The main predictors of the pain incidence included ambulatory phlebectomy, female gender, and advanced age. Satisfaction was significantly higher in foam sclerotherapy group (P = 0.024). Also, this group had shorter time to return to work (P < 0.001). Conclusion: Foam sclerotherapy is more preferred to ambulatory phlebectomy for treating varicosis in small veins of the leg because of its lower morbidity, less pain, more satisfaction, and shorter time to return to work.

QUALITY OF LIFE OF HYDROCELE PATIENTS AFTER TRADITIONAL SURGERIES AND SCLEROTHERAPY

The article analyzes quality of life of hydrocele patients after traditional surgeries and sclerotherapy. It is shown that pain intensity in the sclerotherapy group was 1.1 ± 0.10 points and lower than in the open surgery group where it was 2.6 ± 0.20 points. Physical activity in patients after sclerotherapy was 1.2 ± 0.20 points, while after traditional surgery it was 2.8 ± 0.24 points. Furthermore, mean number of inpatient bed-days and time to return to normal life were significantly lower in the sclerotherapy patients compared to patients who underwent open surgery.

Surgical Excision With Bleomycin Irrigation: A Better Primary Treatment Choice for Pediatric Submandibular Lymphatic Malformations

To compare the efficacy of surgical excision combined with intralesional bleomycin irrigation with that of needle aspiration with intralesional bleomycin sclerotherapy (IBS) in pediatric submandibular lymphatic malformations (LMs). The medical records of 32 patients were analyzed. Clinical response was categorized by improvement in size as determined by imaging studies and calculations of lesion volume. An excellent response was defined as a decrease in volume greater than 90%, a satisfactory response was defined as a decrease greater than 50%, and a poor response was defined as a decrease less than 50%. In addition, the authors developed a new scale to quantify treatment outcome. This scoring system is composed of 6 parts: size decrease, esthetic problem, functional problem (eg, breathing, eating, and speech), postoperative complications, necessity for further intervention, and times of intervention. Pearson χ2 and t tests were used to compare treatment outcome between the 2 groups. The average age at first treatment was 2years. Twenty-two patients underwent surgical excision with bleomycin irrigation as the primary treatment. Three of the 22 underwent 2 rounds of cyst aspiration with IBS during follow-up. IBS was performed as the primary treatment in 10 patients. All patients underwent a single surgery, and the number of IBS procedures per patient varied from 1 to 3 (mean, 1.8). In the surgical group, 72.7% of patients (16 of 22) showed an excellent response, 18.2% (4 of 22) showed a satisfactory response, and 9% (2 of 22) showed a poor response. The surgical excision group had a significantly higher excellent response rate than the sclerotherapy group (P < .05). According to the new scale, there was a marked difference between the mean values of the 2 groups (14.2 ± 2.1 vs 9.8 ± 1.8), and surgical excision with bleomycin irrigation showed better efficacy than IBS. Surgical excision with bleomycin irrigation is a better primary treatment for pediatric submandibular LMs. Cyst aspiration with IBS is a good method to treat localized recurrence.

Study to compare open surgery, endovenous thermal ablation and ultrasound guided foam sclerotherapy for treatment of varicose veins

Introduction and Objective: To compare open surgery, Endovenous thermal ablation(EVTA) and ultrasound(USG) guided foam sclerotherapy for primary superficial venous insufficiency(PVI) with respect to obliteration of superficial venous system at 3 months, clinical outcome and cost.Materials and Methods: Between January 2015 to January 2016, all patients with symptomatic PVI of lower limbs who were willing for definitive management were randomized to open surgery (n=20), EVTA (n=40) or ultrasound guided foam sclerotherapy (n=20). In foam sclerotherapy group, review USG was done at 1 week and if necessary re-injection was done. The patients in all the groups underwent review USG at 3 months. Obliteration of superficial venous system, clinical outcome and costs were registered.Results: 5 patients in foam sclerotherapy group required re-injection at 1 week. Superficial venous system was obliterated in all the patients of all the groups at 3 months. Improvement in clinical score was similar in all groups. The foam sclerotherapy group had less frequent analgesia intake, earlier return to normal activity and lower cost. Local complication rate was slightly higher in foam sclerotherapy group.Conclusion: Foam sclerotherapy is a cheaper alternative to open surgery &amp; EVTA for PVI with respective to early measures of clinical outcome. USG guided sclerotherapy demonstrated to be a safe and effective procedure for the treatment of chronic venous insufficiency. The observed complications were minimal and most of the patients reported satisfaction with the treatment outcomes. If patient have no cost issue, endovenous thermal ablation of varicose veins is better than open surgery &amp; foam sclera in context of minimally invasive, cosmetic, less pain, no incisions, early ambulation &amp; same day discharge.

A Prospective Randomized Study Comparing Polidocanol Foam Sclerotherapy with Surgical Treatment of Patients with Primary Chronic Venous Insufficiency and Ulcer

To compare polidocanol foam sclerotherapy with surgical treatment of patients with primary chronic venous insufficiency and active ulcer treated at a single vascular center. Fifty-eight limbs of 56 patients with active ulcers were prospectively randomized to undergo either surgical treatment or foam sclerotherapy. Patients completed the Aberdeen Varicose Veins Questionnaire (AVVQ), the Venous Clinical Severity Score (VCSS), and Venous Disability Score (VDS). The follow-up was 502 ± 220 days. The ulcer healed in 100% and 91.3% of patients treated with surgery or foam sclerotherapy, respectively (P > 0.05). There were no significant differences in AVVQ, VCSS, and VDS between the 2 groups after the procedures (P = 0.45, 0.58, and 0.66, respectively; Mann-Whitney U test). Complications occurred in 14.2% and 13.0% in the surgical and foam sclerotherapy groups, respectively. Surgical treatment and foam sclerotherapy achieved high rates of ulcer healing, without a statistically significant difference. Both treatments led to significant improvements in VCSS, VDS, AVVQ scores, demonstrating improvements in clinical outcomes and quality of life.

Sclerotherapy with bleomycin versus surgical excision for extracervical cystic lymphatic malformations in children.

Sclerotherapy (ST) with bleomycin is an effective treatment for cervical cystic lymphatic malformations (LM) in children. However, its efficacy for treating extracervical cystic LM in children has not been investigated adequately. This retrospective study compares the efficacy of ST with surgery for treating extracervical cystic LM in children. The subjects of this study were children treated for extracervical cystic LM at our hospital between 1970 and 2013. We evaluated retrospectively the hospital records of these children for age, gender, presenting symptoms, location of the lesion, radiological findings, treatments, complications, duration of hospitalization, and outcome. We analyzed the records of 70 children (M:F=1:9) with a mean age of 52.57±54.87months (range 1-204months). The number of children treated by surgery alone, ST alone, and surgery plus ST was 53 (77%), 13 (18%), and 4 (5%), respectively. Surgery comprised total excision (n=41), near-total excision (n=9), partial excision (n=6), and incisional biopsy (n=1). The complication and recurrence rates were lower, the complete response rate was higher, and the length of hospitalization was shorter in the ST group than in the surgery group (5 vs. 15% and 8 vs. 17%, respectively, p<0.05; 91 vs. 77%, respectively, p=0.05; and 2.42±1.67 vs. 13.57±16.24days, respectively, p=0.03). ST is as safe as surgery for extracervical macrocystic or mixed LMs in children, but is much more effective with higher success rates and lower recurrence rates. Thus, ST provides a cost-effective and appropriate mode of treatment for children with extracervical cystic LM.

Postoperative adjuvant OK-432 sclerotherapy for treatment of cervicofacial lymphatic malformations: An outcomes comparison

ObjectivesSurgical treatment of extensive cervicofacial lymphatic malformations is often challenging due to a high rate of postoperative fluid re-accumulation and lesion recurrence resulting from incomplete resection. This study suggests a combined treatment of surgical resection and postoperative adjuvant OK-432 sclerotherapy via closed suction drainage. Using comparative analysis, this study aims to evaluate the efficacy of adjuvant sclerotherapy. MethodsA retrospective chart review was performed on patients who underwent surgical resection of cervicofacial lymphatic malformations between January 2009 and July 2013. Patients were divided into two groups based on whether or not adjuvant OK-432 sclerotherapy was administered via closed suction drainage after surgery. Both surgery-related and adjuvant sclerotherapy-related complications were assessed, and treatment effectiveness was measured based on the change in Cologne Disease Score (CDS) or the need for further treatment. ResultsA total of 17 patients underwent surgical resection. Nine of these patients underwent surgical resection only, while the other eight underwent surgical resection with adjuvant OK-432 sclerotherapy. The increase in total Cologne Disease Score (CDS) and change of progression parameters were significantly higher for the adjuvant sclerotherapy group compared to the surgery-only group. Additionally, there were no cases of postoperative lymphatic fluid retention among the adjuvant sclerotherapy group. The two groups exhibited similar complication rates with no statistically significant difference. ConclusionsAdjuvant OK-432 sclerotherapy via closed suction drainage is a safe and effective treatment modality. The combination of surgical resection and post-operative adjuvant sclerotherapy via closed suction drainage should be integrated into the treatment algorithm of extensive cervicofacial lymphatic malformation.

English

CONTEXT (BACKGROUND): Primary/Idiopathic hydrocele is defined as an abnormal collection of serous fluid in tunica vaginalis whose cause is not known as it is neither associated with the disease of testis or epididymis. Surgery is considered as a definitive treatment, though the reason of injection treatment falling out of favour is ill understood as studies have shown this technique to be efficacious, safe, cost effective treatment modality in idiopathic hydroceles. This neglect, in part appears to be based on poor evidence presented by previous studies which show inconsistent results. Thus there appears to be lacunae in our knowledge with regards to the usage of aspirationsclerotherpay as the first line of management in select patients. AIM: To compare the results of Injection Sclerotherapy and Surgery for the management of idiopathic hydrocele with respect to post procedure complications like pain, scrotal edema, wound infection, recccurence and the costs involved. MATERIAL AND METHODS: Patients presenting with primary vaginal hydrocele from May 2009-May 2012 were considered in the study. Diagnosis was ascertained by detailed history taking and clinical examnination. Of the 60 Patients in the study, 30 each were randomly designated to treatment by surgery or aspiration-sclerotherapy. Sclerotherapy group were treated on an outpatient basis and those selected for surgery were treated after admission as in-patients. STATISTICAL ANALYSIS USED: Diagrammatic presentation, Mean +/SD, Kruskall Wallis test, Chi square test. RESULTS: 70% cases undergoing sclerotherapy achieved primary cure. Among 30% recurrences, 13.33% achieved cure after 2nd session of sclerotherapy and 16.67% after 3rd session. Initial pain was more in sclerotherapy group whereas edema was more in Jaboulay’s surgery group. All patients in sclerotherapy group were discharged on the same day while average duration of hospital stay was 6 days in surgery group. There was nearly 7 fold difference in the costs in favour of sclerotherapy. CONCLUSIONS: Sclerotherapy is highly effective, safe and economical procedure that permits one to avoid an operation, anesthesia and hospitalization in patients who are either nor fit, don’t desire for surgery. Its use is warranted in adults, particularly in elderly.

Aspiration and sclerotherapy versus hydrocoelectomy for treating hydrocoeles.

Hydrocoeles are common cystic scrotal abnormalities, described as a fluid-filled collection between the visceral and parietal layers of the tunica vaginalis of the scrotum. There are two approaches for treatment of hydrocoeles: surgical open hydrocoelectomy and aspiration followed by sclerotherapy. We compared the benefits and harms of aspiration and sclerotherapy versus hydrocoelectomy for the management of hydrocoeles. We searched the Cochrane Renal Group's Specialised Register to 2 August 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Randomised controlled trials (RCTs) and quasi-RCTs comparing aspiration and sclerotherapy versus hydrocoelectomy for the management of hydrocoeles. Two authors independently extracted data and assessed risk of bias in the included studies. Random effects meta-analyses were performed using relative risk (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). We found four small studies that met the inclusion criteria. These studies enrolled 275 patients with 282 hydroceles. Participants were randomised to aspiration and sclerotherapy (155 patients with 159 hydroceles) and surgery (120 patients with 123 hydroceles). All studies were assessed as having low or unclear risk of bias for selection bias, detection bias, attrition bias and selective reporting bias. Blinding was not possible for participants and investigators based on the type of interventions. Blinding for statisticians was not reported in any of included studies.There were no significant difference in clinical cure between the two groups (3 studies, 215 participants: RR 0.45, 95% CI 0.18 to 1.10), however there was significant heterogeneity (I² = 95%). On further investigation one study contributed all of the heterogeneity. This could be due to the agent used or perhaps due to the fact that this is a much older study than the other two studies included in this analysis. When this study was removed from the analysis the heterogeneity was 0% and the result was significant (in favour of surgery) (2 studies, 136 participants: RR 0.74; 95% CI 0.64 to 0.85).There was a significant increase in recurrence in those who received sclerotherapy compared with surgery (3 studies, 196 participants: RR 9.37, 95% CI 1.83 to 48.4). One study reported a non-significant decrease in fever in the sclerotherapy group (60 participants: RR 0.25, 95% CI 0.06 to 1.08). There was an increased number of infections in the surgery group however this increase was not statistically significant (4 studies, 275 participants): RR 0.31, 95% CI 0.09 to 1.05; I² = 0%). Three studies reported the frequency of pain in the surgery group was higher than aspiration and sclerotherapy group but because of different measurement tools applied in these studies, we could not pool the results. Radiological cure was not reported in any of the included studies. There was no significant difference in haematoma formation between the two groups (3 studies, 189 participants: RR 0.57, 95% CI 0.17 to 1.90; I² = 0%). Only one study reported patient satisfaction at three and six months; there was no significant difference between the two groups. Postoperative complications as well as cost and time to work resumption were less in the aspiration and sclerotherapy group; however the recurrence rate was higher. The cure rate in short-term follow-up was similar between the groups, however there is significant uncertainty in this result due to the high heterogeneity. There is a great need for further methodologically rigorous RCTs that assess the effectiveness of different type of sclerosant agents, sclerosing solution concentration and injection volume for the treatment of hydrocoeles. It is important that the RCTs have sufficiently large sample size and long follow-up period. Studies should evaluate clinical outcomes such as pain, recurrence, satisfaction, complications and cure using validated instruments. The protocols for all studies should be registered in clinical trial registries and the reports of these studies should conform with international guidelines of trial reporting such as CONSORT. Cost-effectiveness studies should also be undertaken.