Lymphoedema Evidence Library › Topics › Lymphatic leak and lymphocele
Lymphatic leak and lymphocele
Lymphatic leak and lymphocele (vascular surgery)
67 sources
Evidence in one minute
- Groin lymphatic complications follow 11.5% of common femoral endarterectomies (112/977), with age ≥80 a risk factor. Fistula without infection → conservative care or radiotherapy; infected lymphorrhoea → NPWT (Szilagyi 1), muscle flap plus NPWT (2), patch replacement plus flap plus NPWT (3). Practice description, no comparison. Uhl 2020
- Varicose vein surgery: groin lymphocele 1.3% and lymphorrhoea 0.7%; blue-dye mapping and preservation of groin lymphatics are proposed (uncontrolled). Dessalvi 2018
- Incision direction: a transverse groin incision gives fewer wound infections (RR 0.25, low), but lymphorrhoea was numerically more frequent (RR 2.77, 0.92–8.34; very low) — do not cite it as lymph-sparing (revised 2026-10-08). Canteras 2020
- NPWT: prophylactic incisional NPWT after node dissection reduced lymphorrhoea and lymphoedema in an era-confounded cohort (very low); NPWT closed a recurrent groin leak after three failures (single case), but major groin bleeding of 7.1% is reported with NPWT after arterial reconstruction. Poirier 2022 · Cannata 2021
- Abdominal lymphocele: drain, then sclerose, then embolise. Khorshidi 2021
- Chyle leaks: about 76% close with fasting, TPN and somatostatin; repeated intranodal lipiodol lymphangiography or thoracic duct embolisation closes refractory leaks. Dalci 2023 · Kariya 2015 · Bundy 2019
Groin and limb leaks
- Leg lymphoedema after groin dissection (EAGLE FM RCT): about half at 6 months and a third to a half at 2 years; adding pelvic dissection did not significantly increase it (31% v 45% at 24 months; closed at 88 of 634) — low. Lee 2024
- Imaging-guided treatment: ICG timing and axillary drainage; lymphocele injection exposing an embolisable lymphopseudoaneurysm in post-operative chylous ascites. Bourgeois 2025 · Verhalleman 2025
- Other: canal of Nuck lymphatic cyst; topical tacrolimus for leaking skin lymphatic vesicles; treatment of lymphatic malformations (13 patients). Cornacchia 2019 · Salvia 2021 · Shiraishi 2025
- Held in the NPWT library, not duplicated here: Abai 2007 (lymphorrhoea responds to NPWT, case series), Tsutsumi 2026 (ICG plus NPWT for intractable inguinal lymphorrhoea; prosthetic grafts excluded), Ahmed 2026 (murine prophylactic negative pressure).
- Operating on a groin lymphocele: map the afferent lymphatics with isosulfan blue at the knee (or a radiocolloid), excise the cavity, ligate every feeding lymphatic and seal with fibrin glue; fill recurrent cavities with a gracilis flap. In 19 groin lymphoceles this gave no recurrence. Lymphatic grafting or transposition of contralateral groin lymphatics is an alternative. Quilting sutures reduce seroma, compression does not; sclerotherapy (doxycycline, alcohol, bleomycin) is variably successful. Isosulfan blue causes serious hypotension in 0.75%. Textbook evidence, case series. Greene 2015 · Baumeister 2017
Chylous ascites, chylothorax and chyluria
- AVF handbook summary: chylous ascites follows 1.1% of abdominal cancer operations (7.4% after retroperitoneal surgery); chyle triglycerides >110 mg/dL (14% of chylothoraces fall below); conservative care closes 71–100% of postoperative chylous ascites; operate on chylothorax draining >1 000 mL/day; thoracic duct embolisation succeeds in about 71% overall (90% once the duct is catheterised), less in non-traumatic effusions; after aortic reconstruction, a brief conservative trial, then ligate the fistula; peritoneovenous shunts occlude early. Gloviczki 2024
- Chyloperitoneum: a 58-patient algorithm; post-operative chylous ascites in children responds to TPN and octreotide. Dessalvi 2016 · Pio 2019
- Chest: neonatal chylous effusions over 20 years; lymphography with 3D CT for chylopericardium. Anvekar 2021 · Rosa 2014
- Lymphangioleiomyomatosis (LAM): serum VEGF-D supports the diagnosis; sirolimus treats chylous and lymphatic disease. Mou 2016 · Hecimovic 2015 · Chachaj 2012 · Gupta 2014
- Filarial chyluria: treat coexistent conditions first (urinary obstruction, pregnancy, heart failure) — 41% of 323 Okinawan cases were aggravated by one and often remitted; oil lymphography locates lymphourinary fistulae and was followed by remission in about half (uncontrolled). Koga 1990 · Gandhi 1976 · Rajaram 1970
Gaps and warnings
- Only one small randomised comparison is held (incision direction). Lymphocele management rests on textbook case series; no trial compares sclerotherapy agents, mapping-guided ligation or lymph-sparing incisions after arterial surgery — the natural next search for vascular practice.
For the therapist
- Do: recognise groin lymphorrhoea and lymphocele early; use moderate compression and skin protection; refer persistent or infected leaks.
- Stop: repeated aspiration of a recurrent lymphocele without surgical review.
- Certainty: case series only.
For a vascular surgeon in South Africa
- Expect a groin lymphatic complication after about 1 in 9 femoral endarterectomies; for an infected leak over a graft or patch, escalate from NPWT to muscle flap to patch replacement, and weigh the bleeding risk of NPWT over arterial repairs.
- Lipiodol lymphangiography and thoracic duct embolisation need interventional radiology; conservative chyle-leak care closes most leaks.
How the evidence points
| High | Mod. | Low | V. low | None | |
|---|---|---|---|---|---|
| Positive | 0 | 0 | 1 | 0 | 0 |
| Null or negative | 0 | 0 | 2 | 0 | 0 |
Sources on this page with a comparison, by the result of their primary outcome and the GRADE certainty of their main finding (Mod. = Moderate, V. low = Very low, None = not graded). Context sources are not counted. How direction is decided.
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