Abdominal Lymphatic Malformations: A Novel Approach in Management

Area of Science:

• Pediatric Surgery
• Interventional Radiology
• Vascular Anomalies

Background:

• Abdominal lymphatic malformations (LM) present significant surgical challenges due to their infiltrative nature and potential for complications.
• Traditional treatments like complete excision are often not feasible, and sclerotherapy may require multiple anesthesias without definitive results.

Purpose of the Study:

• To evaluate a novel treatment algorithm for pediatric abdominal lymphatic malformations.
• To assess the efficacy and safety of a combined interventional radiology (IR) and laparoscopic approach.

Main Methods:

• A retrospective observational study of 12 children treated between January 2019 and December 2023.
• Utilized laparoscopic vision for IR-guided pigtail catheter insertion for maximal drainage and anatomical assessment.
• Treatment involved either surgical resection or IR-guided sclerotherapy based on intraoperative findings.

Main Results:

• Nine children underwent drainage with surgical resection, showing no recurrence at a mean follow-up of 29 months.
• Three children underwent drainage with sclerotherapy; two required further treatment with a mean follow-up of 7.6 months.
• The combined approach facilitated curative resection where feasible with no significant morbidity.

Conclusions:

• A combined IR-guided drainage and laparoscopic approach enables successful surgical resection of abdominal lymphatic malformations when feasible.
• For unresectable lesions, direct intralesional sclerotherapy offers effective long-term symptom control.