After 1 hour, the sclerosing agent was aspirated from the cavity and the drainage tube was removed. Three patients with four lymphoceles underwent sclerotherapy immediately after percutaneous insertion of a drainage tube and aspiration of the lymphocele. No patients underwent previous sclerosis with any agent Although percutaneous procedures have gained a degree of acceptance for treatment of lymphoceles, success rates for aspiration and drainage have been less than optimal. The authors investigated transcatheter sclerosis of pelvic lymphoceles with povidone-iodine as a method to increase the success rate of percutaneous management After percutaneous drainage of lymphoceles, there may be persistent, prolonged drainage output and reaccumulation of lymphatic fluid. In an attempt to achieve cure rates with percutane- 241 242
Sloane CE, Bramis J, Herranen M, Yeh HC, Haimov M, Glabman S, Burrows L: Peritonealization of lymphoceles complicating renal transplantation: Dangers of percutaneous aspiration. South Med J 70(11):1364-1366, 1977. Google Scholar 10. Haaga JR, Weinstein AJ: CT-guided percutaneous aspiration and drainage of abscesses MATERIALS AND METHODS: Percutaneous catheter drainage of 23 symptomatic lymphoceles was performed with ultrasonographic (US) guidance in 20 patients who had undergone radical pelvic lymphadenectomy because of uterine malignancy. All lymphoceles were diagnosed on the basis of biochemical and cytologic findings in aspirated fluid The percutaneous drain was upsized and/or exchanged when residual fluid was not adequately drained by the existing catheter, when there was difficulty with flushing the catheter, or when there was pericatheter fluid leakage
The following are indications of percutaneous drainage of fluid collections: Fluid collection (potential abscess) with enhancing wall by contrast-enhanced computed tomography (CT) in the setting of sepsis. Fig. 15.1 Bilateral pelvic lymphoceles with pressure symptoms on the urinary bladder. (A) Contrast-enhanced axial computed tomography (CT. Lymphocele Drainage Cpt Code. World congress of endourology program arlene morrow cpc cmm cmscs for mcvey bard biopsy lower limb drainage ming for icd 10 michael a ferragamo md. Invasive interventional procedure s cpt code 2016 national aapc coding updates for deb oct 29 on vimeo ropriate cpt codes for pas claims final 2005 emedny radiology ion. Image guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst) peritoneal or retroperitoneal, percutaneous Notes in the CPT® manual state that a drainage code should be assigned for each individual collection drained with a separate catheter
Moreover, the use of various sclerosing agents, such as povidone iodine, sirolimus-cyclosporine, doxycycline, and fibrin sealant glue 8-11,16 for percutaneous drainage of lymphocele cavities has reduced the recurrence rate. However, surgical therapy remains as the definitive, although invasive, method for the treatment of symptomatic lymphocele percutaneous aspiration or drainage alone. Bacterial colonization developed in three persistently draining lymphoceles. However, no clinical sepsis or bacteremia occurred. In another patient with persistent high-volume lymphatic output, sclerotherapy with tetracycline instillation was successful in rapidl Image-guided catheter-directed percutaneous drainage alone is a well-documented treatment option for postoperative lymphoceles, with success rates ranging from 50% to 87% in most series (1, 4, 6, 7, 8, 9). Unfortunately, after percutaneous catheter drainage alone, there may be persistent drainage of fluid resulting in lymphocele reaccumulation Successful lymphocele treatment means complete resolution of lymphocele after minimally invasive procedures - percutaneous drainage with a vascular catheter followed by sclerotherapy or drainage alone. Opposite - non successful treatment defined when the patient is refered for a surgical management. Secondary Outcome Measures After monolateral dual kidney transplantation, a 69 years old male patient developed symptomatic lymphocele with mild hydroureteronephrosis, impaired renal function, and right inferior limb oedema. A percutaneous ultrasound-guided drainage of the fluid.
Percutaneous catheter drainage of abdominal abscesses and fluid collections has been an established component of radiologic practice for nearly 2 decades. Appropriately, the clinical and technical focus of interventional radiologists has been on pyogenic abscesses because of their potentially lethal course The overall success rate of percutaneous catheter drainage was 93% (28/30). Surgical marsupialization was successful in 7 of 8 patients (88%). We conclude that percutaneous needle aspiration is ineffective in the treatment of symptomatic lymphocele, while percutaneous catheter drainage with tetracycline sclerotherapy is safe and effective
In conclusion contrast-enhanced ultrasound retrograde cystography may be helpful in percutaneous drainage of complex posttransplant lymphocele. 1 Percutaneous ethanol sclerotherapy is a safe and effective treatment for postoperative lymphoceles. The technical success rate is high, the recurrence rate is low, and the complication rate is acceptable. Percutaneous sclerotherapy of lymphoceles is a less invasive alternative to surgical treatment Lymphocele. A lymphocele is a collection of lymphatic fluid within the body not bordered by epithelial lining. It is usually a surgical complication seen after extensive pelvic surgery (such as cancer surgery) and is most commonly found in the retroperitoneal space. Spontaneous development is rare Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol scleortherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15-2900 mL)
Percutaneous treatment can be tailored according to volume of lymphoceles. We generally prefer single session sclerotherapy and 1 day catheter drainage in lymphoceles less than 150 mL, and larger ones are treated by multi-session sclerotherapy until daily drainage decreases below 10 mL . In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15-2900 mL)
Duration of catheter drainage was 4-120 days, substantially longer than is customary for standard fluid collections. Nine of 11 patients were cured by percutaneous aspiration or drainage alone. Bacterial colonization developed in three persistently draining lymphoceles. However, no clinical sepsis or bacteremia occurred Long-term (1-5-week) catheter drainage cured 11 of 14 patients (78.6%). Sclerosing agents may have been beneficial for lymphocele obliteration in three of four patients. For most patients, lymphoceles may be diagnosed and treated successfully using radiologic means . MATERIALS AND METHODS: Percutaneous catheter drainage of 23 symptomatic lymphoceles was performed with ultrasonographic (US) guidance in 20 patients who had undergone radical pelvic lymphadenectomy because of uterine malignancy
Infected lymphoceles should always be managed with external drainage and appropriate antimicrobials (A-II). Internal drainage of lymphocele by laparascopic surgery is the preferred technique in many centers, because it allows radical treatment with minimal trauma for the patient and helps to diminish hospitalization, convalescence, and costs. Percutaneous drainage of the lymphocele combined with sclerotherapy achieved a resolution rate close to 80% . It can be performed with a fibrin sealant, doxycycline, intracavitary bleomycin, ethanol, and talcum. Generally, a percutaneous approach does not require hospital admission and is considered to be less invasive than surgical treatment
CEUS Retrograde Cystography Is Helpful in Percutaneous Drainage of Complex Posttransplant Lymphocele. Di Domenico S(1), Patti V, Fazio F, Moggia E, Fontana I, Valente U. Author information: (1)Department of General Surgery and Organ Transplantation, San Martino University Hospital, Largo Rosanna Benzi 10, 16132 Genoa, Italy Although lymphoceles often regress spontaneously, many may progress, precipitate clinical symptoms, and ultimately require intervention. To date, the best treatment of pelvic lymphoceles has not yet been fully defined. However, laparoscopic marsupialization is a definitive and efficacious surgical alternative to percutaneous drainage Catheter drainage allowed complete clinical and sonographic remission in all cases, and only one asymptomatic recurrence was observed at 3-month and 6-month follow-up. Ultrasound-guided percutaneous catheter drainage has proved to be a well-tolerated, safe, and effective technique in the management of lymphocele that obviates the need for more. The aspiration of chylous fluid was diagnostic, and percutaneous drainage of the pancreatic lymphocele was successful in relieving the patient's symptoms. Lymphocele is defined as an accumulation of lymphatic fluid within a nonepithelialized cavity that occurs as a result of persistent leakage of disrupted lymphatics [ 5 ]
Ultrasound was the primary diagnostic procedure in all patients. Lymphoceles resolved spontaneously in asymptomatic patients (n = 3), and thus these patients were not further treated. All symptomatic patients (n = 6) were treated: 2 underwent percutaneous catheter drainage and 4 underwent transcatheter sclerotherapy (TS) How to cite this URL: Shamsa A, Asadpour A A, Oraee F. Post-cadaveric kidney transplant lymphocele which did not respond to percutaneous drainage. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2021 Jul 10];23:585-7 .GOV Journal Article: Lymphocele Mimicking a Pancreatic Pseudocyst: Imaging Characteristics and Percutaneous Managemen Infected lymphoceles are usually treated solely with percutaneous catheter drainage. Percutaneous treatment can be tailored according to volume of lymphoceles. We generally prefer single session sclerotherapy and 1 day catheter drainage in lymphoceles less than 150 mL, and larger ones are treated by multi-session sclerotherapy until daily.
Furthermore, median drainage on the first day was significantly greater in the LF versus PCD group. After catheter insertion, the PCD group showed a significant decrease in drainage on the following day, but no decrease was observed in the LF group. Conclusions: LF is a safe treatment for symptomatic lymphocele After the HLG, A low-fat, middle-chain triglyceride (MCT) diet was prescribed for him, and drainage decreased to 700 mL on the following day and to approximately 300 ml of serous fluid in the following seventh day. The drain output remained low, and after 10 days of the invasion, the drainage was 50 mL daily and all drains were removed. 2.4
51 Percutaneous Gastrostomy, Percutaneous Gastrojejunostomy, Jejunostomy, and Cecostomy Ji Hoon Shin, Andrew J. Lipnik, Ho-Young Song, and Daniel B. Brown. 52 Percutaneous Biliary Interventions David W. Hunter. 53 Percutaneous Nephrostomy and Antegrade Ureteral Stenting Anne M. Covey and Krishna Kandarpa. 54 Lymphocele and Cyst Drainage and. With the magical stroke of a bureaucratic pen a list of the procedure codes may be removed from the ASC payable list, including several heart and spine procedures..... SOURCE: Beckers Healthcare The 258 procedures CMS plans to cut from the ASC payable list Laura Dyrda - Updated Monday, July 26th, 2021 Print | Email The proposed 2022 Hospital Outpatient Prospective Payment System and ASC. Lymphocele. Common complication (occurs in 15%), may present as a mass, if large may compress ureter. May present as swelling of graft but with normal function. Limb swelling may be present. May be drained with percutaneous technique and sclerotherapy, or intraperitoneal drainage A simple and safe method for management of lymphocele after renal transplantation. J Urol 1983;130(6):1058-9. PMID: 6358528. 42. Alago W.Jr., Deodhar A., Michell H. et al. Management of postoperative lymphoceles after lymphadenectomy: percutaneous catheter drainage with and without povi-done-iodine sclerotherapy Other complications include lymphocele, venous thromboembolism, infection, and urinary incontinence. Catheter-associated complications in the immediate postoperative period should be addressed with urology consultation. 2.5. Surgical Complications in Patients with Penile Cancer. Penile cancer is an uncommon malignancy in developed countries
Interventions for postoperative lymphocele include percutaneous aspiration, laparoscopic, or open peritoneal fenestration. Percutaneous drainage or peritoneal fenestration are associated with complications including infection, bleeding, bladder or ureter injury, and postoperative hernia, as well as, a recurrence rate ranging from 16 to 50% The treatment of large symptomatic lymphocele implies two basic methods: b) surgical approach with internal drainage and marsupialiyation, and b) percutaneous puncture and drainage. In our series (311 transplanted kidneys) the presence of lymphocele necessitating further therapy was recorded in 6.4% (18)
Sclerotherapy of a fluid collection is newly recognized in 2016 CPT® as 49185 Sclerotherapy of a fluid collection (eg, lymphocele, cyst, or seroma), percutaneous, including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance (eg, ultrasound, fluoroscopy) and radiological supervision and interpretation when performed The volume of fluid in the lymphoceles ranged from 500 to 1000 mL. Percutaneous drainage was selected as the initial treatment without success. A laparoscopic peritoneal window was created in all patients under intraoperative ultrasonographic guidance. The mean operative time was 90 minutes. In all patients, the fluid collections resolved after. GFR, which at the time of lymphocele drainage was lower (p¼0.04) for patients in the ﬁbrin glue group (Table 1). After the initial treatment, lymphocele recurrences were found in 12 (26%) patients. There were six (27.3%) in the open group, which required repeat open drainage in three, percutaneous drainage in two, and open wound drainage
Percutaneous drainage was performed for the treatment of pelvic lymphocele (Fig. 2, part a). The creatinine level of drained fluid was 0.53 mg/dL. The external iliac vein stent was inserted and balloon dilatation was done 5 days later (Fig. 2, part b) cele14; and, for lymphoceles recalcitrant to percutaneous drainage, laparoscopic marsupialization of the lympho-cele sac into the peritoneal cavity.15 The use of percuta-neous drainage as initial treatment must be judicious, as studies have demonstrated high lymphocele recurrence rates after percutaneous drainage.6,1 Lymphocele is a surgical complication of renal transplantation with an incidence that ranges from 0.6 to 22%, as reported elsewhere., This lesion is progressive, cause compression on the veins and ureters, and induce deterioration of allograft function., Lymphocele develops because of inadequate ligation of the afferent lymphatic vessels accompanying the recipients' iliac vessels. Ultrasound-guided percutaneous catheter drainage has proved to be a well-tolerated, safe, and effective technique in the management of lymphocele that obviates the need for more invasive surgical procedures. All the patients were male, with a mean age of 29 ± 10 years. The volume of fluid in the lymphoceles ranged from 500 to 1000 mL. Percutaneous drainage was selected as the initial treatment without success. A laparoscopic peritoneal window was created in all patients under intraoperative ultrasonographic guidance