Laparoscopic Excision of Large Retroperitoneal Cystic Lymphatic Malformation in a 21 Month Child.

Bethany Slater, MD, Ashwin Pimpalwar, MD. Division of Pediatric surgery, Michael E Debakey Department of surgery, Baylor college of medicine and Texas Children’s Hospital, Houston, Texas.


Lymphatic malformations of the retroperitoneum are large diffuse malformations extending across different planes. It is difficult to excise them completely whichever approach is used. Laparoscopic approach for their excision has not been described for children less than 2 years old.
To describe our laparoscopic approach for excision of large retroperitoneal cystic lymphatic malformation in a 21 month child.
Material and Methods:
The charts of the 21 month child with large retroperitoneal cystic lymphatic malformation were retrospectively reviewed.
An incision was made in the scar of the umbilicus and a 3mm one-step expandable port was introduced. Thereafter a 3 mm 30-degree telescope was introduced after pneumoperitoneum was achieved with CO2 of 5 liters/ minute and a pressure of 12 mm Hg. Once adequate pneumoperitoneum was achieved, two more ports were placed, one in the midline and one in the left flank. Both of them were 3 mm one-step ports. Using the grasper, it was found that there was a large retroperitoneal lymphatic cyst behind the cecum and the ascending colon going right up to the liver and into the pelvis. Using the hook diathermy, the cyst was gently and meticulously dissected. It was possible to completely remove the cyst with all its attachments without any problems. There were no complications. The rest of the peritoneal cavity looked pristine. At the end of the procedure, the mesentery of the appendix was taken down with a harmonic scalpel and the appendix was resected using three 2-0 PDS Endoloops and removed through a 5mm port. The mesenteric cyst was also pulled out through the port site without difficulty. Once this was done, the peritoneal cavity was inspected again and the ports were withdrawn under vision. The umbilical fascia was closed with 2-0 Vicryl on a UR6 needle.
The child was on full feeds by 24hrs and was discharged home in 48 hrs. At 3 months and 6 months follow up the child scars were almost invisible. US abdomen did not reveal any residual or recurrent lymphatic malformation.
Laparoscopic excision of large retroperitoneal cystic lymphatic malformation in children less than 2 years old is feasible and safe, provides excellent cosmesis and has all the other advantages of laparoscopy. Laparoscopic approach may be attempted in selected cases to prevent large scars and morbidity associated with it.

Session Number: Poster – Poster Presentations
Program Number: P569
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