Laparoscopic-assisted management of paediatric intra-abdominal lymphatic malformations

Abstract

Aims

Lymphatic malformations (LMs) are low-flow vascular anomalies with treatment modalities that include conservative, sclerotherapy, oral therapeutic agents and surgical excision. The use of laparoscopy combined with interventional radiology has not previously been described. We report our multidisciplinary (MDT) approach to the management of these lesions.

Methods

All complex paediatric LM referrals are discussed at our vascular MDT that spans across general paediatric surgery, interventional radiology (IR), plastics, orthopaedics, ENT, and dermatology. Intra-abdominal LM’s undergo an initial USS followed by contrast-enhanced MRI to confirm diagnosis and delineate the nature of the lesion. Our first-line treatment has previously been US-guided sclerotherapy. More recently, we have changed our approach to perform an intra-operative assessment of these lesions combined with IR to confirm the diagnosis and assess their resectability.

Results

Four patients have undergone combined assessment with our IR team in the last 24 months ranging from 1 to 7 years of age. Two lesions were found to involve the distal ileum, one proximal jejunum and one greater omentum. In all cases, the lesions were excised following initial laparoscopic assessment combined with IR-guided drainage. There have been no complications encountered in these four patients and none have had a recurrence till date.

Conclusions

Primary laparoscopic assessment of an intra-abdominal LM is feasible and enables the confirmation of the diagnosis and assessment of resectability. Morbidity from the use of sclerosant agents and the repeated use of general anaesthesia can also potentially be avoided using this technique.