Lymphatic leak and lymphocele
Lymphatic leak and lymphocele (vascular surgery)
Evidence in one minute
- Groin lymphatic complications follow 11.5% of common femoral endarterectomies (112/977); age ≥80 a risk factor. Fistula without infection → conservative or radiotherapy; infected lymphorrhoea → NPWT (Szilagyi 1), muscle flap + NPWT (2), patch replacement + flap + NPWT (3). Practice description, no comparison. Uhl 2020
- NPWT for a recurrent groin leak (−125 mmHg, 72 h) after three failures — single case; note reported 7.1% major groin bleeding with NPWT after arterial reconstruction. Cannata 2021
- Prophylactic incisional NPWT after node dissection — less lymphorrhoea and lymphoedema in an era-confounded cohort. Poirier 2022
In the NPWT Evidence Library (not duplicated here)
Abai 2007 (lymphorrhoea responds to NPWT, case series), Tsutsumi 2026 (ICG plus NPWT for intractable inguinal lymphorrhoea; prosthetic grafts excluded), Ahmed 2026 (murine prophylactic negative pressure). See ../NPWT/NPWT Evidence Library/clinical-library/evidence/.
Update 2026-10-08 — downloaded evidence
- Transverse vs vertical groin incision (Cochrane): fewer wound infections (RR 0.25, low certainty); lymphocele and lymphorrhoea not clearly different (1 quasi-RCT, very low certainty) — and lymphorrhoea was numerically more frequent with the transverse incision (RR 2.77, 0.92–8.34), so do not cite it as lymph-sparing (revised 2026-10-08). Canteras 2020
Gaps
Only one small randomised comparison held (incision direction). No held source on lymphocele sclerotherapy, ICG-guided ligation or prevention by lymph-sparing groin incisions — a natural next search for vascular practice.
Update 2026-10-09 — open-access batch 1 (2020–2026 trials and reviews)
- Leg lymphoedema after groin dissection (EAGLE FM 2024 RCT): about half of patients at 6 months and a third to a half at 2 years; adding pelvic dissection did not significantly increase it (31% v 45% at 24 months; trial closed at 88 of 634) — low. Lee 2024
How the evidence points
| High | Mod. | Low | V. low | None | |
|---|---|---|---|---|---|
| Positive | 0 | 0 | 1 | 0 | 0 |
| Null or negative | 0 | 0 | 2 | 0 | 0 |
Sources on this page with a comparison, by the result of their primary outcome and the GRADE certainty of their main finding (Mod. = Moderate, V. low = Very low, None = not graded). Context sources are not counted. How direction is decided.