Lymph Fistulas after Inguinal Lymph Node Dissection—Assessment of Risk Factors and Future Treatment Strategies

Abstract

Background: Inguinal lymph node dissections (ILND) have been commonly associated with postoperative complications such as lymphedema, lymph fistula and wound infections. The reported complication rates after ILND range from 14% - 77%, and a rationale for these large differences is the use of a variety of different definitions of complications. Patients and Methods: Files of patients that underwent inguinal lymph node dissection for lymph node metastases at the Department of General and Visceral Surgery of the University Hospital Frankfurt between February 2005 and March 2012 were retrospectively reviewed. Results: 47 patients (65%) developed a lymphatic fistula in the course of the operation, of which 6 patients (8%) underwent reoperations. Surgical side infections (SSI) were seen in 15 patients (21%), all of them harbouring fistulas. Patients presenting with a BMI ≥ 30 kg/m 2 did not develop more fistulas than those with a BMI < 30 kg/m 2 (p = 0.30). Patients who suffered from a lymph fistula had significantly more visits in the outpatient clinic (p =< 0.0001). There was no difference in the complication rate if the procedure was performed by a resident under supervision or a senior surgeon (p = 0.79). Conclusion: In this study, we demonstrated that lymph fistulas are to date a common complication after ILND and lead to reoperations and significantly more outpatient visits. The number of lymph nodes affected and resected, and prior sentinel lymph node dissection, was not associated with a higher complication rate.