Balloon sclerotherapy: a new method for the treatment of truncal varicose veins.

BACKGROUND: Truncal varicose veins may be treated by conventional surgery or endovenous therapy. Endovenous ablation, such as laser or radiofrequency treatment, is less invasive but technically demanding, not cheap and has still the possibility of important side-effects. Moreover the treatment requires in the best case tumescent anesthesia. Catheter based endovenous sclerotherapy has the potential of systemic effects of sclerosing agent and air. We therefore aimed to develop a simple, minimal-invasive and cheap method for the treatment of truncal varicose veins reducing the potential risk of systemic effects of the sclerosing agent to a minimum. METHODS: A double lumen double balloon catheter was developed. Thereby a treatment site within a vein can be isolated from blood for localized administration of a sclerotherapeutic agent. Later, a substantial portion of the therapeutic agent can be removed from the isolated segment thus minimizing the amount necessary. Occlusion of longer varicose segments is achieved by pointwise repetition of the manoeuvre or careful retraction of the expanded balloons with the "catched" sclerotherapeutic agent in between. RESULTS: The application was filed as United States Patent No. 6,726,67 B2. 18 balloon prototypes successfully passed an extensive test series (leak tests, dimension tests, mandrel--, guide wire--and introducer compatibility tests, destructive tests). Three patients with varicosity of the greater saphenous vein and the vena saphena accessoria lateralis, respectively, were successfully treated with complete occlusion of the vessels 10, 6 and 2 months after the intervention. CONCLUSIONS: Balloonsclerotherapy combines two well-established procedures (balloon catheter therapy and sclerotherapy, namely) and promises to be a minimal-invasive and cheap endovenous therapy of truncal varicose veins, requiring local anesthesia at the puncture site only and reducing possible systemic side effects of the sclerosing agent.

The long-term mobility and mortality of patients with peripheral arterial disease following bilateral amputation.

OBJECTIVES: To study the postoperative course, mobility, housing conditions and the mortality following bilateral amputations in patients with peripheral arterial occlusive disease (PAD). DESIGN: Part retrospective, part prospective open study. SETTING: Vascular unit of a university hospital. PATIENTS: Sixty-six consecutive patients with PAD undergoing bilateral trans-metatarsal (TM), below-knee, through-knee and above-knee amputations between 1980 and 1989 were studied. Their medium are at the time of an amputation in the second limb was 58 years (range 27-91 years). CHIEF OUTCOME MEASURES: Initial and subsequent amputation levels, co-morbidity, mobility, housing conditions and mortality were recorded from 1989 until 2001. MAIN RESULTS: Follow-up was 98%. Hospital mortality after amputation of the second leg was 12%. The mortality after 2 years was 38% and after 5 years 69%. At the end of the observation period, truly three patients were still alive (15%). Coronary heart disease was the leading cause of death and accounted for 37%, cerebro-vascular incidents for 14%. During follow-up, 56% of the patients needed at least one stump revision or reamputation to a higher level. Reamputations occurred after TM in 63%, below-knee in 42% and/through-knee amputations in 69%, respectively. Of 58 patients who were discharged, 38% became able to walk, 52% were mobile with a wheelchair and 10% remained bedridden. Of the patients who were able to walk, 82% returned to individual homes as compared to 63% of those who were mobile with a wheelchair. CONCLUSIONS: Amputation levels should be kept as distal as possible in the interest of mobility which is one of the primary keys to social reintegration. However reamputations to higher levels are frequent as PAD progresses. The well-known very high mortality is clearly related to generalised atherosclerosis.

Thirteen years follow-up after radical transsternal thymectomy for myasthenia gravis. Do short-term results predict long-term outcome?

OBJECTIVE: Long-term evaluation of efficacy and quality of life after radical surgical approach for myasthenia gravis (MG). Comparison between short-term follow-up and long-term outcome. METHODS: All patients (n=26, 16 men and 10 women, mean age: 40.7 years) underwent total transsternal thymectomy for MG between 1986 and 1989. Prospective analysis of the patients for short-term follow-up (mean 22.4 months) was published in 1991. The same group of patients was reevaluated in 2001 (range of follow-up 11.4-15.2 years) and assessed according to the classification of Osserman and Oosterhuis. RESULTS: Mean follow-up was 13.0 years (range 11.4-15.2 years). Two patients were lost from follow-up and one died 4 years after thymectomy for reasons unrelated to MG (n=23). No early or late postoperative mortality was observed. One sternal osteomyelitis occurred. Late postoperative morbidity included sternal instabilities (n=2), mild residual thoracic pain (n=6), and hypertrophic scars (n=7). Five patients were rehospitalized for aggravating MG and needed plasmapheresis (n=3) and intubation (n=1). Thirteen patients (56.5%) showed objective clinical improvement, including six patients (26.1%) with complete remission. Eleven patients (47.8%) do not take any medication at all. Because some late relapse may occur several years after operation, the rate of improvement decreased slightly, whereas the difference between short and long-term follow-up was not statistically significant (P=0.405). Twenty patients (87%) returned to work, including part-time occupation (n=4). Fourteen patients (61%) are performing sports regularly. CONCLUSIONS: Our data confirm that radical, transsternal thymectomy is an effective and safe therapeutic modality for MG. Short-term results seem to deteriorate over time, therefore long-term studies for minimally invasive approaches have to prove equal results before replacing the standard procedure.

Randomized controlled trial of laparoscopic transabdominal preperitoneal hernioplasty vs Shouldice repair.

BACKGROUND: There is a scarcity of data on long-term results after laparoscopic hernia repair. Herein we report on the outcome of a group of patients who were followed up for 5 years in a multicenter study on hernia repair. METHODS: A total of 100 patients with 127 hernias were randomized to undergo either transabdominal preperitoneal (TAPP) or Shouldice hernia repair. Follow-up was by clinical examination and standardized questionnaire. RESULTS: Of the 100 patients who underwent surgery, 84 were available for follow-up at 5 years. The TAPP procedure was less painful than the Shouldice repair, with fewer patients receiving narcotic analgesics. The median time to return to 100% activity was shorter in the laparoscopic group (21 days) than in the Shouldice group (40 days). Up to 60 months after the operation, the complication rate was lower in laparoscopically repaired hernias (19/66) than in the open group (25/61). There were two recurrences (3.9%) in the TAPP group and five in the Shouldice group (10.2%). CONCLUSION: The TAPP hernia repair yields comparable or better results than Shouldice herniorrhaphy in terms of postoperative pain, recovery, and recurrence rate.

[Palliative surgery for primary and secondary thoracic malignancies]. / Chirurgische Palliation im Thoraxbereich bei primären und sekundären Malignomen.

Palliative thoracic surgical interventions aim to assure or to improve quality of life. They encompass surgical correction of vital complications, treatment of symptoms that limit daily activities, and prophylactic interventions to reduce symptoms and improve prognosis. Interventions are based on statistically proved results as well as on profound clinical experience in oncologic surgery. Because palliation does not intent to cure, such operations require precise patient information and inclusion of the respective patient in decision making. Operability depends on patient general condition and extent of the procedure. If tumor is resected local radicality is the principle goal also in palliative situations, which is adapted to each individual case, especially in the context of multimodal treatment strategies. One of the main indications of palliative thoracic surgery in pulmonary metastasectomy. Using the new laser technology loss of parenchyma is minimal and the rate of lobectomies is reduced from 25% to 4%. With mortality and morbidity of less than 1% the 5-year survival after complete metastasectomy is more than 30%. Tumors of the thoracic wall cause pain and tend to exulcerate; due to their obvious presence they induce anxiety. Their removal and subsequent plastic surgery of the chest wall defect therefore makes sense also in advanced stages. Palliative and curative surgery is one of the pillars in plurimodal treatment of mediastinal tumors, besides its role in obtaining tissue for histologic diagnosis. Thoracoscopic talc pleurodesis has a success rate of more than 90% in malignant effusions if the lung is fully expandable.

[Pericardial empyema as a rare complication of pneumococcal pneumonia]. / Das Perikardempyem als seltene Komplikation der Pneumokokken-Pneumonie.

The case histories of 3 patients hospitalised for severe pneumococcal pneumonia are reported. Electrocardiography showed generalized ST-segment elevations and echocardiography revealed pericardial effusion. Pericardiocentesis was performed and analysis of the punctate fluid was consistent with empyema. The pericardial empyema was removed by percutaneous drainage in one patient and by thoracoscopy in 2. During the course of the disease, 2 patients developed constrictive pericarditis after 4 to 6 weeks, necessitating epi- and pericardectomy in one. When patients with pleuropneumonia present generalised ST-segment elevations in the ECG, the possibility of pericardial involvement should be evaluated by echocardiography. The pericardial empyema must be removed as soon as possible, ideally by thoracoscopic drainage. Percutaneous drainage often fails to evacuate the empyema completely and does not prevent recurrent effusions. Constrictive pericarditis occurs early in the course of the disease and is a serious complication. When a patient suffering from constrictive pericarditis remains symptomatic despite optimal conservative therapy, pericardectomy should be performed. However, as only one of our three patients required the procedure, it should not be routinely performed.

[The indications for and results of video thoracoscopic sympathectomy]. / Indikationen und Ergebnisse der videothorakoskopischen Sympathektomie.

BACKGROUND AND OBJECTIVES: Thoracoscopic sympathectomy, for years an effective way to treat mainly palmar and axilla hyperhidrosis, experienced a revival since the application of the principles of minimally invasive surgery. We report the personal experiences of three surgeons with this technique, as well as patients' view of the outcome. PATIENTS AND METHODS: Between January 1990 and November 1997, 73 procedures were performed in 43 patients (23 males, 20 females, mean age 38.1 years, range 15-82 years), and the outcome was prospectively studied. Palmar hyperhidrosis without axilla symptoms was the indication for the operation in 27 patients (54 sympathectomies), Raynaud's syndrome in 15 (18 sympathectomies), and causalgia in one. Thoracic ganglia 2-4 were always completely resected. Perioperative morbidity as well as patient satisfaction in the long-term course (standardized interview) 25.8 (1-77) months postoperatively were assessed. RESULTS: The complication rate in all 73 sympathectomies was 8.2%. Only two severe incidents were observed: in one patient intermittent Horner's syndrome (1.4%) occurred, and in another severe bleeding required conversion to open surgery (1.4%). Both complications occurred in the early study phase. The initial success rate in all 27 patients with hyperhidrosis was 100%. In 30% of these cases a mild partial relapse was observed, which did not interfere with their daily activities. 53% of the patients reported compensatory and 23% gustatory sweating. 9% would have refused the operation, had they known these side effects. In all patients with Raynaud's disease the ulcerations healed completely. At the time of the interview, two patients (13%) complained of painless relapses. They too stated that they had refused the operation, if they had known about the relapses. CONCLUSIONS: Even in the longer-term course, thoracoscopic sympathectomy is rated subjectively successful by 93% of patients after treatment of hyperhidrosis of the upper extremities, and by 87% of patients after treatment of Raynaud's disease, despite some untoward effects and partial relapses.

Inguinal mass as a late complication of hip arthroplasty. Differential diagnosis and treatment from a vascular surgical perspective.

We report on three patients with a symptomatic inguinal mass as a late complication of repetitive arthroplastic hip surgery. In one case, there was a false aneurysm and in two cases a so-called "synovial cyst". A synovial cyst is usually an enlarged iliopsoas bursa in communication with the capsule of the hip joint. Hypersecretion in arthritic joints may cause expansion of this bursa. Compression of the common femoral and external iliac veins may lead to outflow obstruction and leg swelling. The most important diagnostic tools are plain films of the hip joint and ultrasound of the groin including colour-coded assessment of the femoral vessels. Symptomatic cysts usually need removing by an anterior approach. Loose arthroplastic components can be causative and should be replaced.

[Systematic scientific quality improvement in surgical specialties. The AQS mode]. / Systematische wissenschaftliche Qualitätssicherung in den chirurgischen Fächern: Das Modell der AQC.

BACKGROUND: How can the new legal requirements (Law on Statistics 1992 with its corresponding regulations of 1993: minimum data record of the Federal Department of Statistics (BFS) with ICD codification and the law on medical insurance 1995 with its corresponding regulations of 1996: necessity of documenting quality and efficiency) be integrated into the daily hospital routine with reasonable expenditure of time and costs? METHOD: The BFS minimum data record was combined with additional information on quality improvement on one single questionnaire. The surgical departments of the Hospital Limmattal in Schlieren and the Regional Hospital Bienne founded the Association for Quality Improvement in Surgery (AQC) in 1995 and have tested the AQC system for two years. RESULTS: Until the end of 1997 data from 15,115 surgical procedures were collected in our database. In addition to the more time consuming collection of the "minimal data set of the Federal Department of Statistics (BFS)" which requires between 3 to 10 minutes, the collection of the additional AQC-data will take 1 to 3 minutes. DISCUSSION: There is an increasing expenditure of time and costs as a result of legal requirements. Expenditure may, however, be kept within manageable limits if a single questionnaire serves several purposes simultaneously. The AQC system does not only meet the legal requirements as to systematic quality improvement and BFS statistics, but can also be used for the annual statistics of the clinic, the statistics of individual surgeons, and for hospital comparisons provided other clinics adopt the system as well. There are no standards, reference areas or indicators as yet, but such tools may now be developed much more easily with comprehensive data available through the AQC system. CONCLUSIONS: The AQC system has proved to be a manageable tool in the hospital routine; it could thus be implemented as a wide-area system to provide systematic quality improvement and to meet other statistical requirements.

[Septic pylephlebitis with detection of gas in the portal vein: a rare complication of sigmoid diverticulitis]. / Septische Pylephlebitis mit Nachweis von Gas in der Vena portae: seltene Komplikation der Sigmadivertikulitis.

Pylephlebitis, septic thrombosis of the portal vein and its branches, is an infrequent complication of intra-abdominal inflammatory processes which may lead to thrombosis of the portal vein or to liver abscesses. Air in the protal venous system usually predicts a fatal outcome. The survival rate calculated in all reported cases is less than 25%. It is important to detect portal venous gas early. In detection of portal venous gas, ultrasound and computed tomography are more sensitive than plain radiographs. Pylephlebitis used to be a dreaded complication of appendicitis, but the incidence of this disease has greatly declined since the development of antibiotics and modern surgical techniques. We present two cases of pylephlebitis associated with gas in the portal vein as a result of left colonic diverticulitis treated by bowel resection. In spite of the occurrence of portal venous gas, the outcome may be favourable if this disease undergoes prompt surgical treatment.

[Rupture of a Baker cyst with compartment syndrome. A rare complication of knee arthroscopy]. / Ruptur einer Baker-Cyste mit Compartmentsyndrom. Eine seltene Komplikation der Kniearthroskopie.

We report a case of leakage of irrigation fluid into the extra-articular soft tissue, due to rupture of a Baker's cyst during arthroscopy of the knee joint. A four-quadrant fasciotomy of the calf musculature was performed to prevent the devasting ischemic complications of an imminent compartment syndrome. A survey of the literature reveals no consensus regarding the treatment of such complications. On the contrary, some authors recommend avoiding fasciotomy and waiting for spontaneous reabsorption of the irrigation fluid.

[Does a shower put postoperative wound healing at risk?]. / Gefährdet das Duschen die postoperative Wundheilung?

A prospective randomized study was designed to determine the effect of postoperative water contact on tissue healing. A total of 121 patients undergoing open hernia repair was divided into two groups. The first group was permitted to shower postoperatively, allowing the wound to come into direct contact with the water, the second group was instructed to keep the incision dry. Water contact, wound healing and patient satisfaction were assessed. There was no difference in wound healing between the two groups and no manifest infection.

[Chronic cholestatic liver disease and grand mal seizures]. / Chronische cholestatische Hepatopathie und Grand-mal-Anfall.

HISTORY AND CLINICAL FINDINGS: A 48-year-old woman was hospitalised because of grand-mal seizures. 3 years previously a malignant melanoma had been resected from the skin of the back. She was also known to have chronic cholestasis of unknown cause. On physical examination there were postictal signs, but no neurological abnormalities and no jaundice. INVESTIGATIONS: Biochemical tests demonstrated greatly increased alkaline phosphatase (576U/I). gamma-GT (1556U/I) and leucine aminopeptidase (258U/I). The transaminases were only slightly raised (GOT 113U/I, GPT 82U/I). Magnetic resonance imaging of the brain revealed a single intracerebral space-occupying lesion, compatible with a melanoma metastasis. Endoscopic retrograde cholangiopancreatography discovered a filiform, short stenosis in the choledochal duct, histologically an adenocarcinoma. TREATMENT AND COURSE: The cerebral metastasis was removed stereotactically without complications. A Whipple-type gastroduodenopancreatectomy was performed 2 months later. Histology of an intraoperative liver biopsy revealed Caroli's syndrome (focal intrahepatic biliary dilatation) with congenital hepatic fibrosis. Cholestasis persisted after the operation and was treated with ursodeoxycholic acid. The patient has now been free of symptoms for 3 years. CONCLUSIONS: Caroli's syndrome should be included in the differential diagnosis of chronic cholestasis of unknown cause. The case also demonstrates the justification, under certain conditions, of aggressive treatment even when there are two different malignancies.

Controlled multicenter trial of laparoscopic transabdominal preperitoneal hernioplasty vs Shouldice herniorrhaphy. Early results.

BACKGROUND: In February 1993 a prospective randomized multicenter trial was initiated to compare laparoscopic transabdominal preperitoneal hernioplasty to Shouldice herniorrhaphy as performed by surgeons of nonspecialized clinics. METHODS: Until January 1994, 87 patients with 108 hernias took part in the trial (43 Shouldice and 44 laparoscopic repairs). RESULTS: The laparoscopic procedure took significantly longer than did the open operation but caused less pain as measured by pain analogue score and consumption of paracetamol and narcotics. The postoperative complication rate was 26% in the open and 16% in the laparoscopic group. The patients in the laparoscopic group were discharged earlier and their convalescence was shorter than after open hernia repair. There has been one early recurrence in the laparoscopic and two in the open group to date with a mean follow-up of 201 days. CONCLUSIONS: Laparoscopic hernia repair causes less pain than the conventional operation and enables the patient to return to full work and usual activities earlier. The recurrence rate will not be known for 5 years.

Risk and hazards of video-thoracoscopic surgery: a collective review.

OBJECTIVE: Since 1990, video-thoracoscopy has rapidly gained widespread acceptance. In contrast to conventional thoracoscopy no comprehensive studies of potential risks and hazards have been carried out. To date interest has centered on possible indications and thoracoscopic techniques. Based on a review of the literature, this article summarizes and comments on possible complications. METHODS: In a meta-analysis (Medline, January 1989 until December 1994), all publications dealing with thoracoscopy were collected. Those papers concerned with video-thoracoscopy were further evaluated if the following criterias were fulfilled: first, the endoscopist employed a video-camera connected to the thoracoscope; second, separate entry sites were used for telescope and instruments. RESULTS: Of 345 papers, 145 met the above criterias, 5280 thoracoscopies could be analysed for more than 30 indications. The calculated mortality rate was 0.3% and the complication rate 3.61%. In 55 of all cases (1.04%), the intervention had to be converted to open surgery. CONCLUSIONS: Video-thoracoscopic thoracic surgery has gained acceptances as a complement to open thoracic surgery. It may now be regarded as a safe technique. Nevertheless, serious complications such as implantation metastasis of the thoracic wall after thoracoscopy or injury to the recurrent nerve demonstrate the complexity of thoracoscopic surgery. Practitioners should therefore be proficient in thoracic surgery. The importance of meticulous technique and rigid adherance to safety guidelines even in diagnostic procedures, must be stressed.

[Video-endoscopic surgical technique in established thoracoscopic interventions]. / Videoendoskopische Operationstechnik bei etablierten thorakoskopischen Eingriffen.

The video shows six different established thoracoscopic interventions besides the treatment of spontaneous pneumothorax. Adhesiolysis (1) is demonstrated in a patient with malignant pleural effusion, followed by palliative pleurodesis by talkage (2). Resections of benign extra- (3) and intrapulmonary (4) tumors are shown as well as endoscopic pericardial fenestration (5) and thoracic sympathectomy (6).

[Organization and significance of quality control in recent surgical methods exemplified by 85 consecutive thoracoscopic interventions]. / Organisation und Bedeutung von Qualitätskontrollen neuer Operationsmethoden am Beispiel von 85 konsekutiven thoracoskopischen Eingriffen.

The rapid evolution or rather revolution of minimally invasive surgical techniques is stimulating new technical and clinical innovations. Quality control is of great importance in new areas of technical development where standards do not yet exist. By recording detailed documentation of patient data, indications, operative procedures and initial follow-up we can compare this new technology with the gold standard therapy. This documentation system for thoracoscopic interventions was developed together with the Swiss Group of Laparoscopic and Thoracoscopic Surgeons. This pilot project of 85 consecutive thoracoscopic interventions will demonstrate the acceptability, clinical application and ease with which data can be analyzed. Operative techniques are described in detail: 20 diagnostic interventions with biopsy, 19 apical parietal pleurectomies (+/- resections of bullous lung tissue), 10 therapeutic lung tissue resections, 19 palliative pleurodesis, 5 treatments of pleural empyema, 1 mediastinal tumor resection, 1 esophagectomy, 4 thoracic sympathectomies plus 6 other procedures. Data entry is efficient with mean total time of 10 min for each record. All of the data are entered into a computer database. The possibilities for interpreting and combining this data are presented. The operative techniques can easily be related with history, indications, anesthesia, complications and results. First evaluation of thoracoscopic efficiency is possible. In addition, a detailed analysis of intra- and postoperative complications and of the hospital course can be performed.

Three years' experience in video-assisted thoracic surgery (VATS) for spontaneous pneumothorax.

In a prospective study (June 1990 to June 1993), 79 patients were treated for spontaneous pneumothorax by video-assisted thoracoscopic methods with regular follow-up. The observation time was from 3 to 36 months (mean 19.6 months) and was more than 24 months in 27 patients. In 57 patients spontaneous pneumothorax was primary and in 22 secondary. The 53 male and 26 female patients were aged between 17 and 87 years (mean 37 years). Twenty-one patients were treated thoracoscopically for first episode, 22 for persistent pneumothorax (> 7 days), and 36 for a recurrence. Endoscopic examination failed to reveal any lung alteration in four patients (5.1%), and treatment then consisted of simple drainage. Leaks were sealed 26 times by means of a Roeder loop with local anesthesia and 14 times by wedge resection with endotracheal anesthesia and one-lung ventilation; 34 patients were treated by pleurectomy. No deaths occurred. Surgical morbidity was 3.8%, and the postoperative complication rate was 5.1%. One patient was excluded from the follow-up study after conversion to a thoracotomy for control of arterial bleeding. We noted six recurrences; four occurred in the first 21 days and three after ligation of the leak with a Roeder loop. We conclude that video-assisted thoracoscopic treatment of spontaneous pneumothorax by wedge resection and pleurectomy has a recurrence-free rate of 93.8% (45/48) and is therefore an effective treatment for all forms of spontaneous pneumothorax.

[Minimally invasive thoracic surgery]. / Minimal invasive Thoraxchirurgie.

Surgery of the intrathoracic organs may be performed without compromise of respiratory mechanics considering minimally invasive principles. An analysis of our experience of 373 thoracoscopic interventions reveals that the diverse procedures performed on the pleura (pleurectomy, pleurodesis), on the lung (wedge resection, fistula closure, ligature of parenchymatous leaks) and on other definec anatomical structures such as the sympathetic nerve or the thoracic duct, are effective in the therapy of intrathoracic disease. The most important pathological conditions which may be treated by thoracoscopy are listed. The range of complications (7%) and their causes are discussed. Current developments and innovations are summarized by a short review of the literature.

[Does administration of fibrin glue prevent development of lymphoceles after radical lymphadenectomy?]. / Verhindert die Applikation von Fibrinkleber die Entwicklung von Lymphocelen nach radikalen Lymphadenektomien?

Surgical approaches to the groin and axilla, almost radical lymph node dissections (RLND) are followed frequently by lymphocysts. In a prospective randomized study of 30 inguinal or axillary RLND we used at half of the cases 1 ml of the two-component fibrin glue (Tissucol), applied as a spray to seal the wound at the end of the operation. At 27 patients not only a prophylactic RLND but a selective hyperthermic cytostatic perfusion of the extremity was performed because of a locally advanced malignant tumor. There was no difference between the two groups of patients in age, diagnosis, surgical technique, and follow-up. In two cases of the fibrin glue (FG)-group and in 4 cases of the control group a second intervention because of a local wound healing problem had to be performed. The mean amount of postoperative drainage fluid was 1065 +/- 822 ml at the FG-group and 1332 +/- 1093 ml at the control group. Also postoperative drainage time (9 vs. 12 days) and postoperative hospital stay (18 vs. 22 days) were shorter at the FG-group, however, without statistical significance. 11 of 14 patients of the FG-group and 10 of 14 patients of the control group had normal scars after lymphadenectomy without signs of lymphocysts at the clinical follow-up. At our high risk patients (very high amount of postoperative drainage fluid in comparison to other series) prophylactic fibrin glue sealing after RLND could not prevent lymphocysts and lymphatic fistulae.