Laparoscopic intracavitary catheterization combined with bleomycin quadruple sclerotherapy for retroperitoneal lymphatic malformations: a single-center case series.

BACKGROUND

Retroperitoneal lymphatic malformations (rLMs) are rare congenital anomalies with deep, complex anatomy adjacent to vital structures. Traditional treatments (open surgery, percutaneous sclerotherapy) carry high complication and recurrence rates. This study evaluated laparoscopic intracavitary catheterization combined with bleomycin quadruple sclerotherapy for massive cystic/multiloculated rLMs, aiming to establish a standardized minimally invasive paradigm.

METHODS

We retrospectively analyzed 5 pediatric patients with massive rLMs treated at our institution (2022-2023) using this sequential strategy. Perioperative data (operation time, blood loss, cyst fluid volume), postoperative recovery (ambulation, oral intake, hospital stay), sclerotherapy outcomes, and long-term follow-up (recurrence, complications) were reviewed. Complications were formally graded using the Clavien-Dindo classification.

RESULTS

All 5 patients completed treatment without conversion to open surgery or adjacent organ injury. Mean operation time was 128 ± 25 min, blood loss 2 ± 2 mL, and cyst fluid aspiration 135 mL (80-200 mL). All ambulated within 6 h, resumed oral intake at 20 ± 3 h, and had a mean hospital stay of 12 ± 6 d. No patient required analgesic intervention. According to the Clavien-Dindo classification, one patient experienced a grade I complication (self-limiting abdominal discomfort), with no higher-grade complications observed. During a median follow-up of 46 months (43-48 months), all 5 children achieved clinical cure, defined as the absence of symptoms and complete radiographic resolution on imaging (ultrasound/CT), with no recurrence.

CONCLUSION

Laparoscopic intracavitary catheterization combined with bleomycin quadruple sclerotherapy is a minimally invasive, effective, and safe strategy for massive rLMs. It overcomes limitations of traditional treatments with minimal trauma, precision, and a favorable complication profile. The standardized protocol is reproducible, offering a new minimally invasive option for managing this rare retroperitoneal anomaly.