Tratamento de linfocele mediante ecoescleroterapia com polidocanol: relato de casos e revisão / Polidocanol echosclerotherapy treatment for lymphocele: case report and review

Resumo A formação de linfocele, resultante da transecção dos canais linfáticos durante procedimentos cirúrgicos ou traumas, é relativamente comum, sendo relatada em aproximadamente 30% dos pós-operatórios de ressecção de linfonodos. Ela pode evoluir assintomática ou pode apresentar complicações, como dor, infecção secundária, compressão de vasos sanguíneos, a qual evolui para estase, trombose e edema. Seu tratamento ainda é de difícil consenso. Este artigo propõe descrever três casos em que o tratamento foi realizado a partir de ecoescleroterapia com polidocanol. Sua relevância está na escassez de relatos na literatura.

Abstract Formation of lymphocele secondary to transection of lymphatic channels during surgical procedures or traumas is relatively common and is reported in the postoperative period of approximately 30% of lymph node resection procedures. The condition may be asymptomatic or can present with complications such as pain, secondary infection, and compression of blood vessels, which can cause stasis, thrombosis, and edema. There is no consensus on treatment. This article describes three cases in which treatment was provided using polidocanol echosclerotherapy. Its relevance lies in the scarcity of reports in the literature.

Uni- vs. multiloculated pelvic lymphoceles: differences in the treatment of symptomatic pelvic lymphoceles after open radical retropubic prostatectomy

PURPOSE: To evaluate the treatment of symptomatic pelvic lymphoceles (SPL) after performing radical retropubic prostatectomy (RRP) and pelvic lymphadenectomy (PLA) simultaneously. MATERIAL AND METHODS:We analyzed, in a retrospective study, 250 patients who underwent RRP with PLA simultaneously. Only patients with SPL were treated using different non- and invasive procedures such as percutaneous aspiration, percutaneous catheter drainage (PCD) with or without sclerotherapy, laparoscopic lymphocelectomy (LL) and open marsupialization (OM). RESULTS: Fifty-two patients (21 percent) had postoperative subclinical pelvic lymphoceles. Thirty patients (12 percent) developed SPL. Fifteen patients with noninfected uniloculated lymphocele (NUL) healed spontaneously after performing PCD. The remaining seven patients required sclerotherapy with additional doxycycline. After performing PCD, NUL healed better and faster than noninfected multiloculated lymphocele (NML) (success rate: 80 percent vs. 16 percent, respectively). Twenty-seven percent of patients treated initially with PCD, with or without sclerotherapy had persistent lymphocele. All patients were successfully treated with LL. Only one patient had an abscess as a major complication of a persistent SPL after PCD and sclerotherapy and was treated via an open laparotomy. CONCLUSIONS: Symptomatic NUL can be treated using PCD with or without sclerotherapy. If this therapy fails as first-line treatment, laparoscopic lymphocelectomy should be considered within a short period of time in order to achieve successful treatment. NML should be treated using a laparoscopic approach in centers where this type of expertise is available. Infected lymphoceles are drained externally. In these cases, percutaneous or open external drainage with adequate antibiotic coverage is preferable.

Tratamiento videolaparoscopico del linfocele postransplante renal / Videolaparoscopic treatment of postransplant lymphocele

El desarrollo de linfocele postrasplante renal es una complicación que ocurre con relativa frecuencia y se considera la marsupialización peritoneal dentro de las alternativas más efectivas. Se realiza el análisis del tratamiento videolaparoscópico del linfocele postrasplante en 5 pacientes. El tiempo operatorio promedio fue de 40 minutos, con una estadía hospitalaria promedio de 2 días. No se registraron complicaciones inherentes al procedimiento. Se concluye que el mismo es seguro y efectivo y se lo considera el tratamiento de elección de esta patología