From the Guidelines
Retroperitoneal lymphocele management should start with conservative treatment, and if persistent, surgical re-exploration is indicated. Management of retroperitoneal lymphoceles involves a stepwise approach, with the goal of minimizing morbidity, mortality, and improving quality of life.
Key Considerations
- Conservative management is often sufficient for asymptomatic or small collections, and includes observation with serial imaging 1.
- For symptomatic lymphoceles, percutaneous drainage with ultrasound or CT guidance is a common first-line intervention.
- Surgical interventions, such as laparoscopic or open marsupialization into the peritoneal cavity, may be necessary for recurrent or complex lymphoceles.
Prevention Strategies
- Meticulous ligation of lymphatic vessels during surgery can help prevent lymphocele formation.
- Minimizing dissection in lymphatic-rich areas and using fibrin sealants may also be beneficial.
- Limiting dissection to the anterior walls of the vessels, careful use of electrocautery and clips during dissection, and meticulous multilayered closure can also reduce the risk of lymphocele development 1.
Important Considerations
- Lymphoceles can develop due to disruption of lymphatic vessels during retroperitoneal surgery, with risk factors including extensive lymph node dissection, immunosuppression, anticoagulation, and obesity.
- Prompt management is crucial to prevent complications such as infection, compression of adjacent structures, and thrombosis.
- The choice of management strategy should be individualized based on the size, symptoms, and location of the lymphocele, as well as the patient's overall health status.
From the Research
Management Options
- Surgical reexploration and ligation of leaking lymphatics has been reported as an effective treatment for retroperitoneal lymphoceles 2
- Laparoscopic fenestration of the lymphocele and laparoscopically assisted ligation of the leaking lymphatics combined with internal drainage can provide long-term relief of compression symptoms 2
- Retroperitoneal laparoscopic ligation of the leaking lymphatics is a safe and minimally invasive therapeutic method for treating retroperitoneal lymphoceles after abdominal aortic repair 3
- Laparoscopic peritoneal drainage using methylene blue instillation is a simplified approach to drain lymphoceles after radical prostatectomy plus pelvic lymphadenectomy 4
Minimally Invasive Methods
- Percutaneous catheter drainage and sclerotherapy are commonly used mini-invasive methods for treating symptomatic lymphoceles 5
- Percutaneous aspiration, catheter drainage, sclerotherapy, and lymphangiography with lymphatic embolization are available minimally invasive treatment options for abdominal lymphoceles 6
Treatment Approach
- Only symptomatic lymphoceles should be treated 5
- A suggested algorithm for managing lymphoceles includes percutaneous aspiration, catheter drainage, sclerotherapy, and lymphangiography with lymphatic embolization 6
- Surgery either via laparoscopy or laparotomy remains an option in recurring, poorly accessible or inflammatory lymphoceles 5