Vacuum-Assisted Suction Drainage as a Successful Treatment Option for Postoperative Symptomatic Lymphoceles

Abstract

Purpose Lymphoceles often occur within several weeks or even months after surgery. Mostly asymptomatic and therefore undiagnosed, they may be self-healing without any treatment. A small percentage of postoperative lymphoceles are symptomatic with significant pain, infection, or compression of vital structures, thus requiring intervention. Many different treatment options are described in the literature, like drainage with or without sclerotherapy, embolization of lymph vessels, and surgical approaches with laparoscopy or laparotomy. Inspired by reports stating that postoperative suction drainage can prevent the formation of lymphoceles, we developed a simple protocol for vacuum-assisted drainage of symptomatic lymphoceles, which proved to be successful and which we would therefore like to present.

Materials and Method Between 2008 and 2020, 35 patients with symptomatic postoperative lymphoceles were treated with vacuum-assisted suction drainage (in total 39 lymphoceles). The surgery that caused lymphocele formation had been performed between 8 and 572 days before. All lymphoceles were diagnosed based on biochemical and cytologic findings in aspirated fluid. The clinical and imaging data were collected and retrospectively analyzed.

Results In total, 43 suction drainage catheters were inserted under CT guidance. The technical success rate was 100 %. One patient died of severe preexisting pulmonary embolism, sepsis, and poor conditions (non-procedure-related death). In 94.8 % of symptomatic lymphoceles, healing and total disappearance could be achieved. 4 lymphoceles had a relapse or dislocation of the drainage catheter and needed a second drainage procedure. Two lymphoceles needed further surgery. The complication rate of the procedure was 4.6 % (2/43, minor complications). The median indwelling time of a suction drainage catheter was 8–9 days (range: 1–30 days).

Conclusion The positive effects of negative pressure therapy in local wound therapy have been investigated for a long time. These positive effects also seem to have an impact on suction drainage of symptomatic lymphoceles with a high cure rate.

Key Points: 

• Suction drainage of lymphoceles is an easy and successful method to cure symptomatic lymphoceles at various locations.

• We believe this to be due to the induction of cavity collapse and surface adherence.

• In most cases rapid clinical improvement could be obtained.

Citation Format

• Franke M, Saager C, Kröger J et al. Vacuum-Assisted Suction Drainage as a Successful Treatment Option for Postoperative Symptomatic Lymphoceles. Fortschr Röntgenstr 2022; 194: 384 – 390

Zusammenfassung

Ziel Lymphozelen können innerhalb von Wochen oder sogar Monaten nach chirurgischen Eingriffen auftreten. Bleiben diese asymptomatisch, werden sie meist nicht diagnostiziert und heilen von selbst aus. Ein kleiner Prozentsatz der postoperativen Lymphozelen wird jedoch symptomatisch mit Schmerzen, Infektionszeichen oder Kompression von benachbarten Strukturen, was eine Therapie erfordert. Viele verschiedene Behandlungsmethoden sind in der Literatur beschrieben, wie Drainageeinlage mit oder ohne Sklerotherapie, Embolisation von Lymphgefäßen oder chirurgische Operation mit Laparoskopie oder Laparotomie. Inspiriert durch Berichte über postoperative Saugdrainagen, die eine Ausbildung von Lymphozelen verhindern, haben wir ein einfaches Protokoll für eine Vakuum-assistierte Saugdrainage von symptomatischen Lymphozelen entwickelt, welches sich bei uns bewährt hat. Dieses Protokoll möchten wir im Rahmen dieser Studie vorstellen.

Material und Methoden Von 2008–2020 wurden 35 Patienten mit symptomatischen postoperativen Lymphozelen mit unserer Vakuum-assistierten Saugdrainage behandelt (insgesamt 39 Lymphozelen). Ein vorangegangener chirurgischer Eingriff fand zwischen 8 und 572 Tage zuvor statt. Die Diagnose wurde durch eine Untersuchung des Aspirats biochemisch und zytologisch bestätigt. Die klinischen Daten und Bilddaten wurden gesammelt und retrospektiv analysiert.

Ergebnisse Insgesamt wurden 43 Saugdrainagen unter CT-Kontrolle eingebracht. Der technische Erfolg lag bei 100 %. Ein Patient starb leider aufgrund einer vorbestehenden Lungenarterienembolie, einer Sepsis und einem schlechten Allgemeinzustand. Bei 94,8 % der Lymphozelen konnte eine komplette Ausheilung erreicht werden. Vier Lymphozelen benötigten eine zweite Drainage aufgrund eines Rezidivs oder einer Drainagedislokation. Zwei Lymphozelen wurden letztendlich bei fehlender Ausheilung operiert. Die Komplikationsrate der Prozedur betrug 4,6 % (minor complications). Die mittlere Einliegedauer der Drainagen betrug 8–9 Tage.

Schlussfolgerung Die positiven Effekte der Unterdrucktherapie in lokalen Wunden sind schon seit Langem untersucht. Diese positiven Effekte scheinen auch bei der Saugdrainage von symptomatischen Lymphozelen zu einer hohen Ausheilungsrate zu führen.

Kernaussagen: 

• Die Saugdrainage ist eine einfache und schnelle Methode zur Ausheilung von symptomatischen Lymphozelen in verschiedenen Körperlokalisationen.

• Wir glauben, dass dies durch die Kollabierung der Lymphozele und Verkleben der Lymphozelenwand zustande kommt.

• In den meisten Fällen konnte durch unsere Methode ein schnelles Abklingen der Beschwerden erreicht werden.

Key words

symptomatic lymphocele - negative pressure therapy - drainage - interventional procedures

Publication History

Received: 27 May 2021

Accepted: 27 July 2021

Article published online:
14 October 2021

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