Abdominal Lymphatic Malformations (LM): A Novel Approach in Management | Retrospective observational | Single tertiary pediatric centre | Jan 2019-Dec 2023 | 12 children underwent treatment for abdominal LM | 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. | Drainage with sclerotherapy without resection: n=3 | 2 have had further treatment (mean follow up of 7.6 months) | Drainage with resection: n=9 | No signs of recurrence of the LM (mean follow up of 29 months) | Conclusion: A combined procedure of IR-guided drainage under laparoscopic vision allows for curative surgical resection with no significant morbidity. When this is not feasible, intralesional sclerotherapy serves as an effective alternative for long-term symptom control. | https://pubmed.ncbi.nlm.nih.gov/39489681/ | Karunaratne N et al. | Department of Paediatric Surgery, Great Ormond Street Hospital, London, UK | Journal of Pediatric Surgery | @EmGooteeMD | @StayCurrentMD | Cincinnati Children's
Abdominal Lymphatic Malformations: A Novel Approach in Management
Infographic · Apr 2025 · 1 min read
In brief
In brief
This study describes a novel combined approach using laparoscopic-guided drainage with interventional radiology to manage abdominal lymphatic malformations in 12 children. The technique enables intraoperative decision-making for resection versus sclerotherapy, achieving no recurrence in resected cases at 29-month follow-up with minimal morbidity.
- Combined IR-guided drainage under laparoscopy enables intraoperative assessment to determine if curative resection is feasible.
- 9 of 12 patients achieved complete resection with no recurrence at mean 29-month follow-up after drainage-guided approach.
- For unresectable lesions, retained drains allow direct intralesional sclerotherapy as alternative to multiple GA episodes.
- Joint IR-laparoscopy procedure provides both diagnosis and treatment in single session, avoiding staged interventions.
- Novel algorithm achieved zero significant morbidity while enabling definitive treatment decisions based on real-time anatomy.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with cartoon illustrations of diverse children. A map of the UK highlights the treatment location. The layout flows from top to bottom with key statistics in large pink text, treatment details in the middle section with child illustrations, and outcome data presented in contrasting colored boxes. A healthcare provider illustration appears on the right side.
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.