Supermicrosurgical LVA in Abdominal Lymphocele after Gynecologic Cancer Treatment: A Case Report

Kempa S1 , Ried K2 , Zucal I1 , Brebant V1 , Aung T1*, Prantl L1 , Ortmann O2 and Inwald EC2

1Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany 2 Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany

^*Correspondance to: Thiha Aung 

 PDF  Full Text DOI: 10.25107/2474-1647.3012

Abstract

Introduction: Lymphoceles and lymphorrhea are complications often appearing after lymph node excision in oncologic and transplant surgery. Lymphoceles necessitate treatment in complications such as compression of surrounding structures, infection, or presence of fistulas. Lymphovenous Anastomosis (LVA) has been proven to be effective in the treatment of severe lymphedema, but its application for other indications has been scarce. This case report presents the implementation of an LVA in a patient with recurrent pelvic lymphoceles, transperitoneal and transcutaneous fistulas and consequent lymphorrhea. Case Presentation: A 64-year-old woman presented with two abdominal lymphoceles following oncologic surgery of a malignant mixed Mullerian tumor of the left ovary and fallopian tube. A subcutaneous (7 cm ? 6 cm) and intra-abdominal lymphocele (10 cm ? 8 cm) appeared three weeks after surgical treatment and led to pain and grade 3 hydronephrosis of the right kidney. After frustrating repetitive punctures and a revision laparotomy, the patient was assigned to our clinic. The subcutaneous lymphocele could be successfully drained with puncture but the intra-abdominal lymphocele was not accessible for puncture. ICG fluorescent imaging revealed afferent lymphatic vessels conveying fluid to the lymphocele, so they were chosen for LVA implementation. The patient was informed about off-label-use of ICG lymphography. In the follow-up CT two months postoperatively, the intra-abdominal lymphocele completely resoluted and the patient was free of complaints. Conclusion: The indication of LVA-implementation as a treatment option should be enlarged to further lymphatic complications such as lymphocele and consequent lymphorrhea. Additional studies are needed to confirm its efficacy in more patients.

Keywords

Clinical oncology; Indocyanine green; Lymphatic abnormalities; Lymphatic cysts; Microsurgery

Cite the article

Kempa S, Ried K, Zucal I, Brebant V, Aung T, Prantl L, et al. Supermicrosurgical LVA in Abdominal Lymphocele after Gynecologic Cancer Treatment: A Case Report. Clin Surg. 2020; 5: 3012..