title: Lymphocele prevention after pelvic laparoscopic lymphadenectomy by a collagen patch coated with human coagulation factors: a matched case-control study.
abstract: OBJECTIVE
  Lymphoceles are among the most common postoperative complications of pelvic lymphadenectomy (PL), with a reported incidence of 1% to 50%. Symptoms are pelvic pain, leg edema, gastrointestinal obstruction, obstructive uropathy, and deep vein thrombosis, and severe complications such as sepsis and lymphatic fistula formation. After laparoscopic PL, we tested the prevention of lymphoceles using collagen patch coated with the human coagulation factors (TachoSil, Nycomed International Management GmbH, Zurich, Switzerland) on 55 patients with endometrial cancer stages IB to II who had undergone laparoscopy.
  
  
  METHODS
  The authors divided the patients into 2 laparoscopy groups: PL plus TachoSil (group 1: 26 patients) and PL without TachoSil in a control group (group 2: 29 patients), as historical cohort of patients who underwent PL between 2010 and 2012. We collected surgical parameters, and the patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measures were the development of symptomatic or asymptomatic lymphoceles, the need for further surgical intervention, as adverse effect of surgery, and the drainage volume and duration.
  
  
  RESULTS
  The same number of lymph nodes in both groups was removed; group 1 showed a lower drainage volume. Lymphoceles developed in 5 patients in group 1 and in 15 patients in group 2; of these, only 2 patients were symptomatic in group 1 and 5 patients were symptomatic in group 2, without statistical difference and no percutaneous drainage request.
  
  
  CONCLUSIONS
  In this preliminary investigation, the intraoperative laparoscopy application of TachoSil seems to reduce the rate of postoperative lymphoceles after PL, providing a useful additional treatment option for reducing drainage volume and preventing lymphocele development after PL.
authors.affiliation: Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy. andreatinelli@gmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.forename: Ospan A
authors.initials: OA
authors.lastname: Mynbaev
authors.forename: Daniel Alberto
authors.initials: DA
authors.lastname: Tsin
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giorda
authors.forename: Antonio
authors.initials: A
authors.lastname: Malvasi
authors.forename: Marcello
authors.initials: M
authors.lastname: Guido
authors.forename: Farr R
authors.initials: FR
authors.lastname: Nezhat
mesh_terms: D001779:Blood Coagulation Factors / Q000627:therapeutic use; D016022:Case-Control Studies; D004338:Drug Combinations; D016889:Endometrial Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008197:Lymph Node Excision / Q000009:adverse effects*; D008210:Lymphocele / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D015503:Surgical Sponges; D013917:Thrombin / Q000627:therapeutic use*
chemical_list: D001779:Blood Coagulation Factors; D004338:Drug Combinations; C518955:TachoSil; D005340:Fibrinogen; D013917:Thrombin