Evaluation of the therapeutic value of conventional transpedal lymphography for the treatment of inguinal lymphatic fistulas after lymphadenectomy

To evaluate therapeutic effectiveness and safety of lipiodol-based conservative transpedal lymphangiography in sealing persistent inguinal lymphatic fistulas after lymphadenectomy and to determine whether therapeutic success is influenced by the amount of injected Lipiodol or the volume of lymphatic drainage.

From January 2003 to June 2023, 184 patients underwent lymphangiography. Of these, 35 patients (24 males, 11 females; aged 24 to 87 years) met inclusion criteria (age ≥ 18 years, persistent lymphatic leakage after inguinal lymphadenectomy (> 3 weeks), following unsuccessful conservative management) and were subsequently included for statistical analysis. Lipiodol lymphangiography was performed via transpedal lymphatic vessel cannulation. Data collected included the following: age, sex, underlying disease, drainage volume before lymphangiography, Lipiodol amount, procedural details, time to fistula closure, imaging follow-ups, technical success, therapeutic success and its correlation with the volume of lymphatic leakage and the volume of the applied iodised oil, complications, and additional interventions. Statistical analysis utilised the Wilcoxon–Mann–Whitney and logistic regression tests (significance at p ≤ 0.05).

Therapeutic success was achieved in 22 patients (62.86%) without complications, with a mean resolution time of 7.13 days. Thirteen patients (37.14%) required additional interventions. No significant correlation was found between therapeutic success and either the amount of Lipiodol used (p = 0.51 and p = 0.49) or drainage volume (p = 0.82 and p = 0.79).

Lipiodol-based lymphangiography is an effective and safe treatment for inguinal lymphatic fistulas. The lack of association of therapeutic outcome with Lipiodol or drainage volume appears to be more related to anatomical and disease-specific factors, suggesting individualised patient assessment is warranted.