Abdominal Lymphatic Malformations: A Novel Approach in Management

Infographic · Apr 2025 · 1 min read

In brief

UK tertiary center reports a hybrid approach for abdominal lymphatic malformations combining laparoscopic-guided drainage with interventional radiology to determine resectability intraoperatively. Of 12 children treated, 9 underwent successful resection with no recurrence at 29-month follow-up, while 3 received sclerotherapy alone.

Combined IR-guided drainage under laparoscopy enables intraoperative assessment to determine if curative resection is feasible for abdominal LMs
9 of 12 patients achieved successful resection after drainage with no recurrence at mean 29-month follow-up
For unresectable lesions, retained drains allow direct intralesional sclerotherapy as alternative to multiple GA episodes
This hybrid approach avoids complications of blind complete excision while providing definitive diagnosis and treatment planning

Written by the GCMD Library team from the infographic.

A three-column comparison layout with icons representing different surgical procedures. Each column uses distinct colors (blue, green, purple) and includes graphical representations of success percentages, complication rates, and procedural characteristics. Bar charts and circular progress indicators display quantitative outcomes.

Nuwanthika Karunaratne, Kishore Minhas, Premal Patel, Paolo De Coppi, Stefano Giuliani, Dhanya Mullassery, Joe Curry

Aim of the study: Abdominal lymphatic malformations (LM) are a challenging clinical entity. Complete excision can be impossible due to the infiltrative nature of some lesions and high rate of complications. Sclerotherapy may require multiple episodes of general anaesthesia and an inability to be definitive in terms of diagnosis and treatment. Subsequently we have adopted a newer algorithm of treatment involving a joint procedure with interventional radiology to enable an intra-operative treatment plan based on the findings. We present our early results.

Method: A retrospective observational study in a single tertiary paediatric centre from January 2019 to December 2023. The details of each patient were recorded along with their treatment pathway and outcome.

Results: 12 children underwent treatment for abdominal LM. Under GA and laparoscopic vision, pigtail catheters were inserted into the lesion to effect maximal drainage and assessment of surgical anatomy. If resection was feasible this was undertaken through a laparotomy and if not, the drains were retained and sclerotherapy was started.

Three underwent drainage with sclerotherapy without resection and 9 underwent drainage with resection. Of the 3 who underwent sclerotherapy 2 have had further treatment and remain under review at a mean follow up of 7.6 months. Of the other 9 there were no signs of recurrence of the LM at a mean follow up of 29 (range 6–56) months.

Conclusion: We have found a combined procedure involving IR-guided drainage under laparoscopic vision enabling curative surgical resection to be undertaken, where feasible, with currently no significant morbidity. For those in whom this is not possible then direct intralesional sclerotherapy is the next most useful treatment modality for longer term control of symptoms.

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