| Abstract: |
Although many modes of therapy have been described for the treatment of lymph fistulae, no one mode has clearly emerged as the best solution. (Abai et al., 2007).from the operative point of view, authors suggest to pay attention to lymphatic vessels during skin incision and to use magnification devices during LN dissection, using suture material for lymphatic ligations instead of electric coagulation. It is important to use properly the drain tubes, to put them in adequate aspiration associated with proper compression medication on wounds, which might be closed without excessive tension. Proper postural immobilization have to be considered as well. (Francesco et al., 2010).The modality of early surgical exploration of the wound, precise identification of the site of lymph leakage with the assistance of blue dye staining of the lymphatic anatomy and closure of broken lymphatic vessel is mandatory. Less invasive approach using subatmospheric pressure dressing therapy for the treatment of the lymphatic fistulae is very promising. (Rimdeika, 2004).Treatment options for lymphatic fistulae are somewhat controversial. The best option is to prevent fistulae, carefully closing broken (If they can be promptly identified) lymphatic vessels during the surgical procedures using staples or ligatures. Closure using monopolar or bipolar cautery might be insufficient and lead to development of a lymphocele or fistula. from this point, authors suggest that the application of fibrin glue significantly reduces the incidence of lymphatic complications. Application of fibrin glue during closure after exposure of the femoral artery in the Scarpa’s triangle leads to a significant reduction in the incidence of lymphorrhea and lymphoceles. (Giovannacci et al., 2001).Finally, proper follow-up of patients helps in identifying any possible lymphatic complications precociously, and thus to treat it very early allowing to overcome the problem completely. This is adviced to be be applied by all different specialists (General surgeons, vascular surgeons, urologists, gynaecologists, oncologists and radiotherapists) during their daily clinical activity to try to get to the aim of preventing the patients, who undergo risk operations, from fighting also against complex lymphatic acquired disorders such as lymphorrhea, lymphocele, lymphoedema, besides their already more or less serious primary pathological condition. (Francesco et al., 2010).
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