Preoperative complications in children with mesenteric lymphatic malformations: Incidence, risk factors and outcomes
Jiayu Yan1, Li Wang2, Chuanping Xie1
1Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Insights
Mesenteric lymphatic malformations (ML) in children can lead to serious preoperative complications like bleeding and intestinal volvulus. Early diagnosis and treatment are crucial, as cyst location and size are key risk factors.
Area of Science:
- Pediatric Surgery
- Vascular Anomalies
- Gastrointestinal Surgery
Background:
- Mesenteric lymphatic malformations (ML) present diverse and complex preoperative challenges in children.
- Key complications include cyst hemorrhage, infection, and intestinal volvulus, impacting patient outcomes.
Purpose of the Study:
- To analyze the incidence and risk factors of major preoperative complications in pediatric ML patients.
- To explore the influence of these complications on surgical outcomes.
Main Methods:
- Retrospective cohort study of 104 pediatric ML patients from June 2016 to June 2022.
- Classification based on preoperative complications (hemorrhage/infection, intestinal volvulus).
- Logistic regression analysis identified independent risk factors.
Main Results:
- 26.0% experienced preoperative hemorrhage/infection; 21.2% had preoperative intestinal volvulus.
- ML in the mesocolon and larger cyst size (≥7.5 cm) were risk factors for hemorrhage/infection.
- ML in the jejunal mesentery was an independent risk factor for intestinal volvulus.
Conclusions:
- Prompt diagnosis and surgical intervention for ML are recommended.
- Cyst location and size are significant risk factors for hemorrhage/infection.
- Jejunal mesenteric ML is a specific risk factor for intestinal volvulus.
Background:
Preoperative complications of mesenteric lymphatic malformations (ML) in children are various and complex. We aim to analyze the incidences and risk factors of three major preoperative complications (hemorrhage of the cyst, infection of the cyst and intestinal volvulus) in ML patients, and explore their influence on the outcomes.
Methods:
This retrospective cohort study enrolled ML patients undergoing surgery at Beijing Children's Hospital between June 2016 and June 2022 and classified them according to different preoperative complications, preoperative hemorrhage or infection, and preoperative intestinal volvulus. The groups were examined and compared according to sex, age at admission, presenting symptoms, laboratory examinations, imaging examinations, preoperative treatments, cyst characteristics, surgical details, perioperative clinical data, and follow-up. Logistic regression analysis was performed to identify the independent risk factors for preoperative hemorrhage or infection, and preoperative intestinal volvulus.
Results:
Of the 104 enrolled ML patients, 27 (26.0%) had preoperative hemorrhage or infection, and 22 (21.2%) had preoperative intestinal volvulus. Univariate analysis showed that patients with preoperative hemorrhage or infection had a higher rate of ML in the mesocolon (44.4 vs. 23.4%, p < 0.038) and larger cysts (10 vs. 8 cm, p = 0.042) than patients without preoperative hemorrhage or infection. Multivariable logistic regression analysis found that the location (OR, 3.1; 95% CI, 1.1-8.6; p = 0.026) and size of the cyst (≥7.5 cm) (OR, 6.2; 95% CI, 1.6-23.4; p = 0.007) were independent risk factors for preoperative hemorrhage or infection. Preoperative intestinal volvulus was only found in ML at the intestinal mesentery. Further analysis showed that ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus (OR, 3.3; 95% CI, 1.1-10.0; p = 0.027). Patients with preoperative hemorrhage or infection spent more on hospitalization costs than patients without preoperative hemorrhage or infection (3,000 vs. 2,674 dollars, p = 0.038).
Conclusions:
ML patients should be treated as soon as possible after diagnosis. The location and size of the cyst were independent risk factors for preoperative hemorrhage or infection. ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus.
