Management of lymphatic fistulas after arterial reconstruction in the groin

Abstract

Background: Since its original description in the British Medical Journal in 1978, the treatment of lymphatic fistulas in the groin remains contentious. Lymph leaks remain a common cause of morbidity in patients who have undergone groin dissection. The aim of this review was to examine the evidence for prevention and treatment of lymphatic fistulas after arterial surgery in the groin.

Methods: A systematic review of the English language literature was undertaken to determine the success of the various treatment options described.

Results: A comprehensive literature search identified 46 studies describing several treatment options for lymphatic fistulas. A qualitative synthesis of these studies was performed. There was no consensus definition of lymphatic fistula. Treatments reviewed were: conservative management; lymphatic ligation; vascularized muscle flaps; and negative pressure wound therapy (NPWT). Due to poor study quality and the paucity of data no one treatment could be identified as superior.

Conclusions: There was no quantifiable cut-off for either the amount of lymphatic output or number of days postoperatively that leakage continued to help determine when conservative measures should be abandoned and surgical intervention undertaken. There is some evidence supporting use of vascularized muscle flaps to reduce the volume of lymphatic drainage and help prevent secondary graft infection. The use of NPWT is also promising, but must be weighed against the associated risk of anastomotic bleeding and requirement for additional inpatient stay.