Journal of pediatric surgery · 2025
Laparoscopic-assisted resection with adjunct sclerotherapy for abdominal lymphatic malformations: Long-term outcomes from a large cohort study.
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Tran Tam Duc, Pham Hien Duy, Vu Hoan Manh, Tran Nam Xuan, Ly Dung Boi, Dang Trang Thu, Le Dinh Tran Duy, Nguyen Quang Thanh
Аннотация
BACKGROUND: Abdominal cystic lymphatic malformations are rare congenital anomalies in children, often requiring surgical intervention due to the risk of complications. This study aimed to evaluate the safety and efficacy of surgical treatment strategies, including complete excision and adjuvant intralesional Bleomycin sclerotherapy, in a pediatric cohort.
PATIENTS AND METHODS: A retrospective analysis was conducted on 83 pediatric patients (51 males, 32 females) who underwent surgical management for abdominal lymphatic malformations at our institution between January 2017 and December 2021. Demographic data, clinical presentations, surgical approaches, and postoperative outcomes were analyzed.
RESULTS: The mean patient age was 45.6 months. Cysts were most frequently located in the mesentery (43 %), omentum (35 %), and retroperitoneum (22 %). Laparoscopic surgery was performed in 71 cases (86 %), with conversion to open surgery in four (6 %). Complete cyst excision alone was performed in 38 patients (46 %), excision with bowel resection in 26 (31 %), and partial excision with intralesional Bleomycin injection in 19 (23 %). The mean operative time across all procedures was 73 ± 19 min. There were no intraoperative or immediate postoperative complications. Recurrence occurred in 13 patients (16 %), with four requiring reoperation and the remainder managed conservatively. At a median follow-up of 45 months, all patients had complete resolution of disease, and no long-term complications or mortality were observed.
CONCLUSION: Surgical treatment of abdominal lymphatic malformations in pediatric patients is both safe and effective. Complete cyst excision is the preferred approach when feasible, while partial excision combined with Bleomycin sclerotherapy offers a viable option for complex or unresectable cases.
LEVEL OF EVIDENCE RATING: Level III.
PATIENTS AND METHODS: A retrospective analysis was conducted on 83 pediatric patients (51 males, 32 females) who underwent surgical management for abdominal lymphatic malformations at our institution between January 2017 and December 2021. Demographic data, clinical presentations, surgical approaches, and postoperative outcomes were analyzed.
RESULTS: The mean patient age was 45.6 months. Cysts were most frequently located in the mesentery (43 %), omentum (35 %), and retroperitoneum (22 %). Laparoscopic surgery was performed in 71 cases (86 %), with conversion to open surgery in four (6 %). Complete cyst excision alone was performed in 38 patients (46 %), excision with bowel resection in 26 (31 %), and partial excision with intralesional Bleomycin injection in 19 (23 %). The mean operative time across all procedures was 73 ± 19 min. There were no intraoperative or immediate postoperative complications. Recurrence occurred in 13 patients (16 %), with four requiring reoperation and the remainder managed conservatively. At a median follow-up of 45 months, all patients had complete resolution of disease, and no long-term complications or mortality were observed.
CONCLUSION: Surgical treatment of abdominal lymphatic malformations in pediatric patients is both safe and effective. Complete cyst excision is the preferred approach when feasible, while partial excision combined with Bleomycin sclerotherapy offers a viable option for complex or unresectable cases.
LEVEL OF EVIDENCE RATING: Level III.