38. Combination of lymphatic embolization and vessel sclerotherapy for managing bilateral lipoma groin lymphorrhea: Case report and literature review

Tran Que Son, Le Van Khang, Tran Hieu Hoc

Main Article Content

Abstract

Inguinal lymphatic complications frequently occur after radical inguinal lymph node dissection to treat malignant diseases of the genital or anal region. There is no consensus on the treatment method for lymphorrhea. We reported a case of a 66-year-old male patient underwent surgery to remove a bilateral inguinal lipoma tumor. The ultrasound image showed that the tumor size in the right and left inguinal regions was 30x35 and 33x40mm, respectively. The lymphatic leakage volume measured over 500 mL/day through negative pressure drainage on both sides, requiring the dressing to be changed approximately five to seven times daily. A multidisciplinary team of surgeons and interventional radiologists was consulted, and we decided to perform an intranodal lymphangiography to identify the leakage point. The largest lymph node in the groin area, located under the wound, was punctured under ultrasound guidance, and contrast material (Hystoacryl - Lipiodol glue at a ratio of 1:6) was injected into the lymph node. After a week, the sclerosant was injected to destroy the lymphatic vessels and prevent leakage. Hospital stay was 41 days without lymphatic fistula. Conclusion: lymphatic embolization and vessel sclerotherapy therapy is effective for patients with lymph fistula after surgery for inguinal tumors.

Article Details

References

1. Chang SB, Askew RL, Xing Y, et al. Prospective assessment of postoperative complications and associated costs following inguinal lymph node dissection (ILND) in melanoma patients. Ann Surg Oncol. 2010; 17(10): 2764-2772.
2. Nakamura Y, Fujisawa Y, Maruyama H, et al. Intraoperative mapping with isosulfan blue of lymphatic leakage during inguinal lymph node dissection (ILND) for skin cancer for the prevention of postoperative lymphocele. J Surg Oncol. 2011; 104(6): 657-660.
3. Watfa W, Campisi C, Ryan M, et al. Lymphatic Leaks of the Thigh and Inguinal Region: Combined Plastic Surgery Approaches for an Effective Treatment Algorithm. Ann Plast Surg. 2020; 85(6): 661-667.
4. Lemaire V, Brilmaker J, Kerzmann A, Jacquemin D. Treatment of a groin lymphatic fistula with negative pressure wound therapy. Eur J Vasc Endovasc Surg. 2008; 36(4): 449-451.
5. Gerken ALH, Herrle F, Jakob J, et al. Definition and severity grading of postoperative lymphatic leakage following inguinal lymph node dissection. Langenbecks Arch Surg. 2020; 405(5): 697-704.
6. Lv S, Wang Q, Zhao W, et al. A review of the postoperative lymphatic leakage. Oncotarget. 2017; 8(40): 69062-69075.
7. Pham Thi Viet Dung, Nguyen Ngoc Cuong, Thai Duy Quang, et al. Combination of Lymph Node Embolization and Musculocutaneous Flap Operation for Managing Groin Lymphorrhea. Ann Vasc Dis. 2021; 14(3): 267-269.
8. Lee EW, Shin JH, Ko HK, et al. Lymphangiography to treat postoperative lymphatic leakage: a technical review. Korean J Radiol. 2014; 15(6): 724-732.
9. Hur S, Shin JH, Lee IJ, et al. Early Experience in the Management of Postoperative Lymphatic Leakage Using Lipiodol Lymphangiography and Adjunctive Glue Embolization. J Vasc Interv Radiol. 2016; 27(8): 1177-1186 e1171.
10. Baek Y, Won JH, Kong TW, et al. Lymphatic Leak Occurring After Surgical Lymph Node Dissection: A Preliminary Study Assessing the Feasibility and Outcome of Lymphatic Embolization. Cardiovasc Intervent Radiol. 2016; 39(12): 1728-1735.
11. Seyferth ER, Itkin M, Nadolski GJ. Intranodal Glue Embolization for Postoperative Lymphatic Leaks in the Groin and Pelvis: Comparison with Sclerotherapy. J Vasc Interv Radiol. 2023; 34(4): 600-606.
12. Pan F, Loos M, Do TD, et al. Percutaneous afferent lymphatic vessel sclerotherapy for postoperative lymphatic leakage after previous ineffective therapeutic transpedal lymphangiography. Eur Radiol Exp. 2020; 4(1): 60.
13. Cesmebasi A, Baker A, Du Plessis M, Matusz P, Shane Tubbs R, Loukas M. The surgical anatomy of the inguinal lymphatics. Am Surg. 2015; 81(4): 365-369.
14. Rebecca AM, Mahabir RC, Pflibsen L, Hillberg N, Jensen C, Casey WJ, 3rd. Indocyanine Green Lymphangiography as an Adjunct for the Optimal Identification and Management of Lymphatic Leaks in the Groin. J Reconstr Microsurg. 2019; 35(2): 83-89.
15. Kayama E, Nishimoto K, Kaneko G, et al. Embolization Using N-butyl Cyanoacrylate for Postoperative Lymphatic Leakage: A Case Report. Clin Genitourin Cancer. 2018; 16(2): e355-e371.
16. Caretto AA, Stefanizzi G, Fragomeni SM, et al. Lymphatic Function of the Lower Limb after Groin Dissection for Vulvar Cancer and Reconstruction with Lymphatic SCIP Flap. Cancers (Basel). 2022; 14(4).
17. Cope C, Salem R, Kaiser LR. Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial. J Vasc Interv Radiol. 1999; 10(9): 1248-1254.
18. Sun X, Zhou F, Bai X, et al. Application of ultrasound-guided intranodal lymphangiography and embolisation in cancer patients with postoperative lymphatic leakage. World J Surg Oncol. 2021; 19(1): 32.
19. Song S, Parmeshwar N, Steiner G, Kim EA. A Systematic Review and Meta-analysis of Techniques for Management of Postoperative Lymphatic Leaks After Groin Surgery. Ann Plast Surg. 2022; 89(2): 238-244.