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Management von Lymphfisteln in der Leistenregion aus chirurgischer Sicht

Management of lymphatic fistulas in the groin from a surgeon’s perspective

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Zusammenfassung

Hintergrund

Postoperativ auftretende Lymphfisteln der Leistenregion stellen eine ernstzunehmende Komplikation dar. Diese Fisteln führen zu einer Steigerung der Morbidität und können lokale sowie auch aufsteigende Infektionen unterhalten. Die Therapie dieser Komplikation reicht von konservativen Maßnahmen wie Kompressionsverband und Bettruhe bis zur operativen Therapie mittels Lymphfisteldetektion und Ligatur, VAC-Pumpentherapie bis hin zur Muskellappenplastik. Diese Arbeit gibt eine Übersicht über eine Auswahl an Therapiemöglichkeiten.

Material und Methode

Anhand aktueller Literaturrecherche mittels Pubmed wurde eine Auswahl an etwaigen Therapieverfahren identifiziert und beschrieben.

Ergebnisse

Die vorgestellten konservativen Maßnahmen haben nach wie vor ihren Stellenwert. Es wird eine Auswahl sicherer und effektiver interventioneller und operativer Therapieverfahren vorgestellt.

Schlussfolgerungen

Bei der Indikation zur interventionellen bzw. operativen Therapie steht eine Auswahl sicherer und effektiver Therapiealternativen zur Verfügung, die den Krankenhausaufenthalt signifikant verkürzen können. Die Therapie mittels lokaler Muskellappenplastiken hat ihren Stellenwert als Ultima Ratio in der Versorgung von Protheseninfekten in der Leiste vom Typ Szilagyi III und sollte bei Bedarf angewandt werden.

Abstract

Background

The postoperative occurrence of lymph fistulas in the groin is a complication that should be taken seriously. These fistulas cause an increase in morbidity and can support local and ascending infections. The treatment of this complication ranges from conservative procedures, such as compression dressings and bed rest to operative treatment with detection of the fistulas and ligation, negative pressure wound therapy (NPWT) or even muscle flaps. This review provides an overview of current therapeutic modalities.

Material and methods

On the basis of a current literature search via PubMed, we identified possible treatment options, which are described in this article.

Results

The conservative treatment options presented still have an importance in treating groin fistulas. A selection of safe and effective interventional and operative treatments is presented.

Conclusion

If there are indications for an interventional or operative treatment a variety of safe and effective therapies are available, which can significantly reduce the length of hospital stay. The option of treatment using a muscle flap is of value as a last resort in the treatment of infected vascular prosthesis in the groin of Szilagyi type III and should be used when necessary.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    B. Juntermanns, A. E. Cyrek & J. Bernheim

  2. Contilia Herz- und Gefäßzentrum, Klinik für Gefäßchirurgie und Phlebologie, Elisabeth-Krankenhaus Essen, Essen, Deutschland

    J. N. Hoffmann

Authors
  1. B. Juntermanns
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  2. A. E. Cyrek
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  3. J. Bernheim
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  4. J. N. Hoffmann
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Correspondence to B. Juntermanns.

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Interessenkonflikt

B. Juntermanns, A.E. Cyrek, J. Bernheim und J.N. Hoffmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Juntermanns, B., Cyrek, A.E., Bernheim, J. et al. Management von Lymphfisteln in der Leistenregion aus chirurgischer Sicht. Chirurg 88, 582–586 (2017). https://doi.org/10.1007/s00104-017-0378-3

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  • DOI: https://doi.org/10.1007/s00104-017-0378-3

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