Lymphocele Prevention After Pelvic Laparoscopic Lymphadenectomy by a Collagen Patch Coated With Human Coagulation Factors A Matched Case-Control Study

Objective: Lymphoceles are among the most common postoperative complications of pelvic lymphadenectomy (PL), with a reported incidence of 1% to 50%. Symptoms are pelvic pain, leg edema, gastrointestinal obstruction, obstructive uropathy, and deep vein thrombosis, and severe complications such as sepsis and lymphatic fistula formation. After laparoscopic PL, we tested the prevention of lymphoceles using collagen patch coated with the human coagulation factors (TachoSil, Nycomed International Management GmbH, Zurich, Switzerland) on 55 patients with endometrial cancer stages IB to II who had undergone laparoscopy. Materials and Methods: The authors divided the patients into 2 laparoscopy groups: PL plus TachoSil (group 1: 26 patients) and PL without TachoSil in a control group (group 2: 29 patients), as historical cohort of patients who underwent PL between 2010 and 2012. We collected surgical parameters, and the patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measures were the development of symptomatic or asymptomatic lymphoceles, the need for further surgical intervention, as adverse effect of surgery, and the drainage volume and duration. Results: The same number of lymph nodes in both groups was removed; group 1 showed a lower drainage volume. Lymphoceles developed in 5 patients in group 1 and in 15 patients in group 2; of these, only 2 patients were symptomatic in group 1 and 5 patients were symptomatic in group 2, without statistical difference and no percutaneous drainage request. Conclusions: In this preliminary investigation, the intraoperative laparoscopy application of TachoSil seems to reduce the rate of postoperative lymphoceles after PL, providing a useful additional treatment option for reducing drainage volume and preventing lymphocele development after PL.

Tinelli A.1 , Mynbaev O.A. 2, 3 , Tsin D.A.4 , Giorda G.5 , Malvasi A.6 , Guido M.7 , Nezhat F.R.8, 9, 10
Номер выпуска
  • 1 Vito Fazzi Hosp, Dept Obstet & Gynaecol, I-73100 Lecce, Italy
  • 2 Moscow State Univ Med & Dent, Expt Res & Modeling Div, Moscow, Russia
  • 3 Peoples Friendship Univ Russia, Dept Obstet Gynecol & Reprod Med, Moscow, Russia
  • 4 Mt Sinai Hosp, Dept Gynecol, Div Minimal Invas Endoscopy, Queens, NY USA
  • 5 Ist Nazl Tumori, Div Gynecol Oncol, Ctr Riferimento Oncol, Aviano, Italy
  • 6 Hosp Santa Maria, Dept Obstet & Gynaecol, Bari, Italy
  • 7 Univ Salento, Fac Sci, Dept Biol & Environm Sci & Technol, Lab Hyg,Di S Te BA, Lecce, Italy
  • 8 Columbia Univ Coll Phys & Surg, New York, NY 10032 USA
  • 9 St Lukes Roosevelt Hosp, Div Gynecol Oncol, New York, NY USA
  • 10 St Lukes Roosevelt Hosp, Dept Obstet & Gynecol, New York, NY USA
Ключевые слова
Lymphocele; Endometrial cancer; Pelvic lymphadenectomy; TachoSil; Lymph nodes; Radical hysterectomy; Lymphocysts; Drainage; Complications
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Deutsche Zeitschrift fur Philosophie. Том 61. 2013. С. 437-446