Langenbeck's Archives of Surgery

, Volume 391, Issue 4, pp 435–438 | Cite as

Successful doxycycline treatment of lymphatic fistulas: report of five cases and review of the literature

  • Thilo Hackert
  • Jens Werner
  • Martin Loos
  • Markus W. Büchler
  • Jürgen Weitz
Case Management and Clinical Consequences

Abstract

Background and aims

Lymphatic fistulas are commonly known complications after lymph node or soft tissue resection, requiring long and sometimes difficult therapy. Doxycycline is an antibiotic agent, which was used in the treatment of pneumothoraces and pleural effusions. The aim of the study was to evaluate the effect of local doxycycline instillation on postoperative lymphatic effusions.

Materials and methods

Five patients with postoperative lymphatic fistulas of different locations (inguinal, gluteal, and thoracic) were included. Patients received local doxycycline instillation after a postoperative observation period of 19–27 days without spontaneous closure of the fistulas.

Results

Postoperative lymphatic fistulas closed after a single injection of doxycycline in four out of five patients within 2 days, in one patient, injection had to be repeated to achieve closure of the fistula. Drain removal was possible within 4 days after instillation in all patients; no complications occurred.

Conclusions

Doxycycline can be used for treatment of persistent postoperative lymphatic fistulas in different locations. In further studies, this therapeutic concept should be evaluated with larger numbers of patients with regard to the ideal point of time, frequency, and mode of application.

Keywords

Lymphatic fistula Postoperative Doxycycline 

References

  1. 1.
    Serpell JW, Carne PW, Bailey M (2003) Radical lymph node dissection for melanoma. ANZ J Surg 73:294–299 (May)PubMedCrossRefGoogle Scholar
  2. 2.
    Nelson BA, Cookson MS, Smith JA Jr, Chang SS (2004) Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series. J Urol 172:494–497 (Aug)PubMedCrossRefGoogle Scholar
  3. 3.
    Bouchot O, Rigaud J, Maillet F, Hetet JF, Karam G (2004) Morbidity of inguinal lymphadenectomy for invasive penile carcinoma. Eur Urol 45:761–765; discussion 765–766 (Jun)PubMedCrossRefGoogle Scholar
  4. 4.
    Giovannini I, Giuliante F, Chiarla C, Ardito F, Vellone M, Nuzzo G (2005) Non-surgical management of a lymphatic fistula, after laparoscopic colorectal surgery, with total parenteral nutrition, octreotide, and somatostatin. Nutrition 21:1065–1067 (Oct)PubMedCrossRefGoogle Scholar
  5. 5.
    Cnotliwy M, Gutowski P, Petriczko W, Turowski R (2001) Doxycycline treatment of groin lymphatic fistulae following arterial reconstruction procedures. Eur J Vasc Endovasc Surg 21:469–470 (May)PubMedCrossRefGoogle Scholar
  6. 6.
    Clarke SA, Lakhoo K, Sherwood W (2005) Somatostatin for intractable postoperative chylothorax in a premature infant. Pediatr Surg Int 21:390–391 (May)PubMedCrossRefGoogle Scholar
  7. 7.
    Valentine CN, Barresi R, Prinz RA (2002) Somatostatin analog treatment of a cervical thoracic duct fistula. Head Neck 24:810–813 (Aug)PubMedCrossRefGoogle Scholar
  8. 8.
    Heffner JE, Standerfer RJ, Torstveit J, Unruh L (1994) Clinical efficacy of doxycycline for pleurodesis. Chest 105:1743–1747 (Jun)PubMedCrossRefGoogle Scholar
  9. 9.
    Herrington JD, Gora-Harper ML, Salley RK (1996) Chemical pleurodesis with doxycycline 1 g. Pharmacotherapy 16:280–285 (Mar–Apr)PubMedGoogle Scholar
  10. 10.
    Sassoon CS (1995) The etiology and treatment of spontaneous pneumothorax. Curr Opin Pulm Med 1:331–338 (Review, Jul)PubMedGoogle Scholar
  11. 11.
    Ji YZ, Zheng JH, Chen JN, Wu ZD (1993) Microsurgery in the treatment of chyluria and scrotal lymphangial fistula. Br J Urol 72:952–954 (Dec)PubMedCrossRefGoogle Scholar
  12. 12.
    Kwaan JH, Bernstein JM, Connolly JE (1979) Management of lymph fistula in the groin after arterial reconstruction. Arch Surg 114:1416–1418 (Dec)PubMedGoogle Scholar
  13. 13.
    Waclawiczek HW, Pimpl W (1986) Lymph fistulae following lymph node dissections—prevention and treatment using fibrin gluing. Chirurg 57:330–331 (May)PubMedGoogle Scholar
  14. 14.
    Brun JL (1995) Postoperative lymphoceles and lymphatic fistula in gynaecologic and breast neoplasm. Bull Cancer 82:711–716 (Review, Sep)PubMedGoogle Scholar
  15. 15.
    Neu B, Gauss G, Haase W, Dentz J, Husfeldt KJ (2000) Radiotherapy of lymphatic fistula and lymphocele. Strahlenther Onkol 176:9–15 (Jan)PubMedCrossRefGoogle Scholar
  16. 16.
    Browse NL, Wilson NM, Russo F, al-Hassan H, Allen DR (1992) Aetiology and treatment of chylous ascites. Br J Surg 79:1145–1150 (Nov)PubMedCrossRefGoogle Scholar
  17. 17.
    Cope C (1998) Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study. J Vasc Interv Radiol 9:727–734 (Sep–Oct)PubMedCrossRefGoogle Scholar
  18. 18.
    DiBardino DJ, Vanatta JM, Fagan SP, Awad SS (2002) Acute respiratory failure after pleurodesis with doxycycline. Ann Thorac Surg 74:257–258 (Jul)PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Thilo Hackert
    • 1
  • Jens Werner
    • 1
  • Martin Loos
    • 1
  • Markus W. Büchler
    • 1
  • Jürgen Weitz
    • 1
  1. 1.Department of SurgeryHeidelberg 69120Germany

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