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A Systematic Review and Meta-analysis of Techniques for Management of Postoperative Lymphatic Leaks After Groin Surgery. Ann Plast Surg 2022; 89:238-244. [PMID: 35703193 DOI: 10.1097/sap.0000000000003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Plastic surgeons are often consulted to manage postoperative groin lymphatic leaks that may lead to serious sequelae if not promptly treated. Because there are no standardized guidelines for best treatment practices, this systematic review and meta-analysis evaluates the outcomes of multiple management modalities to ultimately guide decision making for surgeons. METHODS Literature surrounding lymphatic leaks in the groin was reviewed from PubMED, MEDLINE, EMBASE, and the Cochrane Library from January 1, 2000, to December 1, 2020 according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The inciting procedure, postoperative lymphatic complication, used management, and days to resolution were recorded. Pairwise comparisons using the Wilcoxon rank sum test with Bonferroni continuity correction were used to determine which treatment modalities differed significantly and accounted for multiple hypothesis testing. RESULTS A total of 1468 total studies were initially found, which narrowed to 267 unique articles after duplicates were removed. Twelve articles ultimately met the inclusion criteria and were included in the data analysis. There were 264 groin complications, of which 217 were initially treated with conservative management, 81 with a minimally invasive procedure, and 125 with surgery. More than 95% of all cases had an inciting procedure of a vascular nature.For vascular surgery-induced lymphatic leak treated by minimally invasive and surgical techniques, a significantly higher number of cases resolved compared with those treated conservatively (100% and 96.7% compared with 29.5%, respectively, P < 0.05). However, there were no significant differences in the proportion that resolved between the minimally invasive and surgical cases (P = 0.11). Vascular cases that were only managed with surgery had significantly shorter days to resolution compared with cases that first attempted conservative management (P < 0.001). CONCLUSIONS Both minimally invasive and surgical options have increased odds of resolution and lower failure rates compared with conservative management alone. The odds of resolution were higher when treated with more invasive procedures compared with conservative-only management, but the mean days to resolution was longer. This meta-analysis depicts successful resolution with procedural management and supports an initial trial of minimally invasive techniques.
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Hautmann MG, Dietl B, Wagner L, Zeman F, Kölbl O, Pfister K, Schierling W. Radiotherapy of Lymphatic Fistulas after Vascular Surgery in the Groin. Int J Radiat Oncol Biol Phys 2021; 111:949-958. [PMID: 34324999 DOI: 10.1016/j.ijrobp.2021.07.1696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Lymphatic fistulas are common complications after vascular surgery especially in the groin, which can lead to a prolongation of the inpatient stay, wound infections and follow-up operations. Radiotherapy is one of the non-surgical treatment options. However, there is limited evidence and discussion about the ideal dosage and timing. METHODS AND MATERIALS The analysis was performed on patients from a German university hospital and included 191 patients with 206 lymphatic fistulas from 2005 to 2016. Four different endpoints were analyzed. The patients were irradiated with a fraction dose of 3 Gy up to a cumulative dose of 9 Gy (94/206 cases) or 18 Gy (112/206 cases). The median age of the patients was 70.5 years with 74% male and 26% female patients. Vascular surgery included bypass grafts (52%), thrombendarterectomy/patch angioplasty (26%), and vascular access for aortic endografts (22%). RESULTS The response to radiotherapy for the four different endpoints was 88% (25% decrease in secretion volume), 80% (secretion below 50 ml/24 hours), 81% (removal of the drainage) and 75% (freedom from any intervention), respectively. The overall response for all four endpoints was 63% (129/206) after completion of radiotherapy, and 34% (70/206) after one course with a total dose up to 9 Gy. The median lymphatic secretion was 150 ml/24 hours before radiotherapy and 60 ml/24 hours one day after the end of therapy. The drainage could be removed a median of 3 days after radiotherapy completion. There was no significant difference between patients starting the radiation within 5-9 days or ≥10 days postoperatively (p = .971 OR = 0.99; 95%-CI: 0.56 to 1.74). No relevant factors influencing the response rate could be identified. Re-operation was required in 50/206 cases (25%), in 24/206 cases (12%) due to persistent lymphatic fistula and complications and in 26/206 cases (13%) due to wound and/or vascular complications. CONCLUSION Radiotherapy seems to be an effective, non-surgical treatment option for reducing lymphatic secretion after vascular surgery in the groin. Starting radiation early (≤9 days) or late (≥10 days) postoperatively does not affect the success rate.
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Affiliation(s)
- Matthias G Hautmann
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany.
| | - Barbara Dietl
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Laura Wagner
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany; Public Health Department, Cologne, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Oliver Kölbl
- Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany
| | - Karin Pfister
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Wilma Schierling
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
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Villiger R, Cabalzar-Wondberg D, Zeller D, Frei P, Biedermann L, Schneider C, Scharl M, Rogler G, Turina M, Rickenbacher A, Misselwitz B. Perianal fistulodesis – A pilot study of a novel minimally invasive surgical and medical approach for closure of perianal fistulae. World J Gastrointest Surg 2021; 13:187-197. [PMID: 33643538 PMCID: PMC7898183 DOI: 10.4240/wjgs.v13.i2.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/20/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Perianal fistulae strongly impact on quality of life of affected patients.
AIM To challenge and novel minimally invasive treatment options are needed.
METHODS Patients with Crohn’s disease (CD) in remission and patients without inflammatory bowel disease (non-IBD patients) were treated with fistulodesis, a method including curettage of fistula tract, flushing with acetylcysteine and doxycycline, Z-suture of the inner fistula opening, fibrin glue instillation, and Z-suture of the outer fistula opening followed by post-operative antibiotic prophylaxis with ciprofloxacin and metronidazole for two weeks. Patients with a maximum of 2 fistula openings and no clinical or endosonographic signs of a complicated fistula were included. The primary end point was fistula healing, defined as macroscopic and clinical fistula closure and lack of patient reported fistula symptoms at 24 wk.
RESULTS Fistulodesis was performed in 17 non-IBD and 3 CD patients, with a total of 22 fistulae. After 24 wk, all fistulae were healed in 4 non-IBD and 2 CD patients (overall 30%) and fistula remained closed until the end of follow-up at 10-25 mo. In a secondary per-fistula analysis, 7 out of 22 fistulae (32%) were closed. Perianal disease activity index (PDAI) improved in patients with fistula healing. Low PDAI was associated with favorable outcome (P = 0.0013). No serious adverse events were observed.
CONCLUSION Fistulodesis is feasible and safe for perianal fistula closure. Overall success rates is at 30% comparable to other similar techniques. A trend for better outcomes in patients with low PDAI needs to be confirmed.
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Affiliation(s)
- Roxanne Villiger
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich 8091, Switzerland
| | | | - Daniela Zeller
- Department of Surgery, Zeller Surgery, Zurich 8008, Switzerland
| | - Pascal Frei
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich 8091, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich 8091, Switzerland
| | - Christian Schneider
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich 8091, Switzerland
| | - Michael Scharl
- Department of Gastroenterology, University Hospital of Zurich, Zurich 8091, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich 8091, Switzerland
| | - Matthias Turina
- Visceral- and Transplant Surgery, University Hospital of Zurich, Zurich 8091, Switzerland
| | - Andreas Rickenbacher
- Visceral- and Transplant Surgery, University Hospital of Zurich, Zurich 8091, Switzerland
| | - Benjamin Misselwitz
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich 8091, Switzerland
- Visceral Surgery and Medicine, University Hospital of Bern, Bern 3010, Switzerland
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Lymphatic Leaks of the Thigh and Inguinal Region: Combined Plastic Surgery Approaches for an Effective Treatment Algorithm. Ann Plast Surg 2020; 85:661-667. [PMID: 32118638 DOI: 10.1097/sap.0000000000002310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical procedures interfering with the draining nodes in the inguinal region carry the intrinsic risk of lymphatic complications. Lesions of the inguinal lymphatic network can lead to lymphocele or lymphocutaneous fistulas and can eventually be associated to limb lymphedema with consequent high morbidity. OBJECTIVES This article describes a new surgical algorithm based on wound properties to properly address lymphatic complications of the inguinal area. Based on our experience, surgical solutions ranged from selective lymphatic vessel ligation to microsurgical lymphatic fistula treatment and free tissue transfer. METHODS Fourteen consecutive patients underwent surgery in our department following failed attempts to address persistent lymphatic leaks. Patient characteristics such as smoking, previous surgeries, comorbidities, and wound properties were considered. Identification of the leak was performed using blue patent dye and indocyanine green fluorescence. Surgical reconstruction occurred, according to our algorithm. RESULTS Lymphatic leaks were visualized in 11 of 14 patients. Direct closure of the wound after leak ligation could be performed in 4 of 14 patients. Multilymphatic into vein anastomosis was performed in 3 of 14 patients, and the remaining patients benefited from flap surgery based on the wound defects. All 14 patients had successful outcomes (100%) with early drain removal (average, 6 [SD, 6] days) and definitive wound healing 2 weeks postoperatively. After a mean follow-up of 12 (SD, 2.9) months, no clinical infection, lymphatic complication, or wound breakdown occurred. One patient had a partial recurrence that did not require surgical intervention. CONCLUSIONS A stepwise approach, combining lymphatic surgery principles and plastic surgery flap techniques, can lead to an effective treatment algorithm where surgical options are wound tailored to guarantee the best functional outcomes.
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Dräger DL, Schmidt S. [Wound drainage after inguinal lymphadenectomy in malignant diseases]. Urologe A 2019; 58:555-558. [PMID: 30968174 DOI: 10.1007/s00120-019-0920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D L Dräger
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland. .,UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland.
| | - S Schmidt
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland
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Juntermanns B, Cyrek AE, Bernheim J, Hoffmann JN. [Management of lymphatic fistulas in the groin from a surgeon's perspective]. Chirurg 2018; 88:582-586. [PMID: 28180975 DOI: 10.1007/s00104-017-0378-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The postoperative occurrence of lymph fistulas in the groin is a complication that should be taken seriously. These fistulas cause an increase in morbidity and can support local and ascending infections. The treatment of this complication ranges from conservative procedures, such as compression dressings and bed rest to operative treatment with detection of the fistulas and ligation, negative pressure wound therapy (NPWT) or even muscle flaps. This review provides an overview of current therapeutic modalities. MATERIAL AND METHODS On the basis of a current literature search via PubMed, we identified possible treatment options, which are described in this article. RESULTS The conservative treatment options presented still have an importance in treating groin fistulas. A selection of safe and effective interventional and operative treatments is presented. CONCLUSION If there are indications for an interventional or operative treatment a variety of safe and effective therapies are available, which can significantly reduce the length of hospital stay. The option of treatment using a muscle flap is of value as a last resort in the treatment of infected vascular prosthesis in the groin of Szilagyi type III and should be used when necessary.
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Affiliation(s)
- B Juntermanns
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland.
| | - A E Cyrek
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - J Bernheim
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - J N Hoffmann
- Contilia Herz- und Gefäßzentrum, Klinik für Gefäßchirurgie und Phlebologie, Elisabeth-Krankenhaus Essen, Essen, Deutschland
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Lv S, Wang Q, Zhao W, Han L, Wang Q, Batchu N, Ulain Q, Zou J, Sun C, Du J, Song Q, Li Q. A review of the postoperative lymphatic leakage. Oncotarget 2017; 8:69062-69075. [PMID: 28978181 PMCID: PMC5620321 DOI: 10.18632/oncotarget.17297] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022] Open
Abstract
Lymphatic complications are rare, but well-known phenomena, and have been described by many researchers. However, many diagnoses of lymphatic complications are found confusing due to different definition. A literature search in Pubmed was performed for studies postoperative lympatic complications. These complications divided into two parts: lymphatic leakage and lymphatic stasis. This review is about lymphatic leakage, especially, postoperative lymphatic leakage due to the injury of lymphatic channels in surgical procedures. According to polytrophic consequences, many types of postoperative lymphatic leakage have been presented, including lymph ascites, lymphocele, lymphorrhea, lymphatic fistula, chylous ascites, chylothorax, chyloretroperitoneum and chylorrhea. In this review, we focus on the definition, incidence and treatment about most of these forms of lymphatic complications to depict a comprehensive view of postoperative lymphatic leakage. We hold the idea that the method of treatment should be individual and personal according to manifestation and tolerance of patient. Meanwhile, conservative treatment is suitable and should be considered first.
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Affiliation(s)
- Shulan Lv
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qing Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Wanqiu Zhao
- Northwest Women's and Children's Hospital, Xi’an, Shaanxi, China
| | - Lu Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qi Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Nasra Batchu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qurat Ulain
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Junkai Zou
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Chao Sun
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jiang Du
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qing Song
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, USA
- Center of Big Data and Bioinformatics, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qiling Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Center of Big Data and Bioinformatics, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Salna M, Takayama H, Garan AR, Kurlansky P, Farr MA, Colombo PC, Imahiyerobo T, Morrissey N, Naka Y, Takeda K. Incidence and risk factors of groin lymphocele formation after venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients. J Vasc Surg 2017; 67:542-548. [PMID: 28822659 DOI: 10.1016/j.jvs.2017.05.127] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) is a well-established therapy for refractory cardiopulmonary failure. Femoral cannulation offers a quick and effective means of providing circulatory support but is not without complication. Inflammation or lymphatic disruption at the site of cannulation can cause the formation of lymphoceles, leading to the patient's discomfort and possibly necessitating intervention. The purpose of this study was to evaluate the incidence of in-hospital lymphocele formation in VA-ECMO patients and to identify predictors for their development. METHODS We conducted a single-center retrospective review of 192 patients who underwent femoral VA-ECMO insertion and subsequent decannulation from March 2007 to August 2016 for cardiogenic shock. Baseline demographics, risk factors, and cannulation strategies were examined. Groin lymphocele formation was assessed as the primary outcome. RESULTS Median age was 58 years (interquartile range, 48-67 years) with a median duration of support of 4 days (interquartile range, 2-6 days). Lymphocele formation was identified in 31 patients (16%). Patients who developed lymphoceles were more likely to have post-heart transplantation primary graft dysfunction (PGD) as an indication for ECMO support compared with those who did not (54.2% vs 8%; P < .001). ECMO duration was similar between groups, but lymphocele patients were more likely to have undergone femoral cutdown procedures (68% vs 42%; P = .010). Compared with those PGD patients who did not develop lymphoceles, PGD lymphocele patients had higher rates of diabetes mellitus preoperatively (62% vs 8%; P = .006). Thirteen (42%) patients required surgical incision and drainage, and 4 of these patients (31%) required repeated surgical intervention. CONCLUSIONS Lymphocele formation is relatively common after femoral VA-ECMO. There was a significantly higher incidence of lymphocele formation in diabetic patients requiring support for PGD after heart transplantation.
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Affiliation(s)
- Michael Salna
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Arthur R Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Paul Kurlansky
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Thomas Imahiyerobo
- Division of Plastic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Nicholas Morrissey
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
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Knee lymphocutaneous fistula secondary to knee arthroplasty. Case Rep Orthop 2015; 2014:806164. [PMID: 25580333 PMCID: PMC4279846 DOI: 10.1155/2014/806164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/01/2014] [Indexed: 11/23/2022] Open
Abstract
Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication. In lower limb, this entity is frequently associated with vascular procedures around the inguinal area. We report on a case of a knee lymphocutaneous fistula secondary to a knee revision arthroplasty. To our knowledge, no previous reports regarding this complication have been published.
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Lymphatic injury at sacrocolpopexy: an unusual complication. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:339-342. [PMID: 24798672 DOI: 10.1016/s1701-2163(15)30610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lymphorrhea is a rare condition with a paucity of reports in the gynaecologic literature. The most frequent causes are invasive procedures and surgical interventions. CASE A multiparous woman underwent a total abdominal hysterectomy with prophylactic bilateral salpingectomy and abdominal sacrocolpopexy for pelvic organ prolapse. During retroperitoneal dissection, clear fluid discharge was encountered. Ureteric injury was subsequently ruled out. A sample of the fluid was taken to confirm lymphatic injury. Ligation suture and closing the peritoneum slowed fluid drainage. CONCLUSION To our knowledge, this is the first reported lymphatic injury in association with a urogynaecologic procedure. Gynaecologists should be aware of this potential complication and should have an approach to diagnosis and management. This case highlights the importance of intraoperative consultation.
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Van den Brande P, von Kemp K, Aerden D, Debing E, Vanhulle A, Staelens I, Haentjens P. Treatment of Lymphocutaneous Fistulas After Vascular Procedures of the Lower Limb: Accurate Wound Reclosure and 3 Weeks of Consistent and Continuing Drainage. Ann Vasc Surg 2012; 26:833-8. [DOI: 10.1016/j.avsg.2012.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 07/14/2011] [Accepted: 02/13/2012] [Indexed: 11/29/2022]
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Singh K, Wang ML, Rubinshteyn V, Sticco C, Deitch J. Case report: doxycycline instillation used to treat a high-output lymphatic fistula secondary to needle puncture. J Wound Care 2011; 20:171-2. [PMID: 21537304 DOI: 10.12968/jowc.2011.20.4.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Previous reports have documented the use of doxycycline as a sclerosing agent in the treatment of recurrent pleural effusion and pneumothoracies. However, little is currently known of its use in the closure of lymphatic fistulae. This paper presents a case in which an infusion of doxycycline was used in a patient who had developed the unusual complication of a high-output lymphatic fistula, following a femoral needle puncture. As no standard of care has been established in the treatment of this problem, we embarked on a minimally-invasive course of action, using doxycycline as a sclerosing agent. We found this treatment to be effective, with no complications.
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Affiliation(s)
- K Singh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Staten Island University Hospital, Staten Island, New York, USA.
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Hackert T, Werner J, Loos M, Büchler MW, Weitz J. Successful doxycycline treatment of lymphatic fistulas: report of five cases and review of the literature. Langenbecks Arch Surg 2006; 391:435-8. [PMID: 16683147 DOI: 10.1007/s00423-006-0050-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 03/03/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Lymphatic fistulas are commonly known complications after lymph node or soft tissue resection, requiring long and sometimes difficult therapy. Doxycycline is an antibiotic agent, which was used in the treatment of pneumothoraces and pleural effusions. The aim of the study was to evaluate the effect of local doxycycline instillation on postoperative lymphatic effusions. MATERIALS AND METHODS Five patients with postoperative lymphatic fistulas of different locations (inguinal, gluteal, and thoracic) were included. Patients received local doxycycline instillation after a postoperative observation period of 19-27 days without spontaneous closure of the fistulas. RESULTS Postoperative lymphatic fistulas closed after a single injection of doxycycline in four out of five patients within 2 days, in one patient, injection had to be repeated to achieve closure of the fistula. Drain removal was possible within 4 days after instillation in all patients; no complications occurred. CONCLUSIONS Doxycycline can be used for treatment of persistent postoperative lymphatic fistulas in different locations. In further studies, this therapeutic concept should be evaluated with larger numbers of patients with regard to the ideal point of time, frequency, and mode of application.
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Affiliation(s)
- Thilo Hackert
- Department of Surgery, Im Neuenheimer Feld 110, Heidelberg 69120, Germany.
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