Gastroepiploic Lymph Node Flap Harvest in Patients with Lymphedema: Minimally Invasive vs. Open Approach
Samyd S. Bustos, MD1, Jospeh Banuelos, MD1, Pedro Ciudad, MD, PhD2, Antonio J. Forte, MD, PhD, MS3, Juliane Bingener-Casey, MD1, Megan Nelson, MD1, Hung-Chi Chen, MD, PhD, FACS4, Oscar J. Manrique, MD1.
1Mayo Clinic, Rochester, MN, USA, 2Arzobispo Loayza National Hospital, Lima, Peru, 3Mayo Clinic, Jacksonville, FL, USA, 4China Medical University,, Taichung, Taiwan.
BACKGROUND: Gastroepiploic lymphatic flaps have become a popular option to treat patients with lymphedema and have widely extended to numerous hospitals and surgical centers. Several methods to harvest this flap have been described. We analyzed complications, efficiency and patient satisfaction scores, comparing the two most common techniques. METHODS: Multicenter, retrospective study. Between 2013 - 2018 all patients with lymphedema and candidates for gastroepiploic flap harvest were included. Two-groups were compared: Open and Laparoscopic approach. Flap harvest time, postoperative complications, pain, return of GI motility, time to discharge and patient satisfaction scores were assessed. RESULTS: A total of 146 patients were included. Ninety-five vs. fifty-one patients underwent laparoscopic and open approach respectively. Average surgical completion time for the laparoscopic vs. open approach was 70 and minutes 122 minutes respectively (p<0.02). Postoperative complications for the laparoscopic vs. open were as followed: 1-patient developed pancreatitis and 2-patients developed ileus in the laparoscopic approach while 3-patients developed ileus, 1-small bowel obstruction, 2-superficial site infection and 1-minor wound dehiscence in the open approach. No patient required further surgical intervention. Average return of GI function was 1-day (laparoscopic) and 2-days (open) respectively. No other complications reported. On a pain scale 1(minor) to 10(severe), pain scores at POD-1 and upon discharge were average 3 vs. 7 and 2 vs. 5 respectively (p<0.05). In addition, intravenous pain medications were required more in the open approach (p<0.03). Hospital discharge was on POD-2 and POD-5 (laparoscopic vs. open) respectively (p<0.004). Patient satisfaction scores based on pain and scars, were significantly better in the laparoscopic group vs. open group 8/10 vs. 5/10 points respectively (p<0.03); having the most common complain a longer and hypertrophic scar and more pain in the open group.
CONCLUSIONS: This data supports that a minimal invasive approach is ideal and efficient when resources are available. In addition, the high patient satisfaction scores give promising feedback to continue offering this technique.
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