WOFAPS 2025 8th World Congress of Pediatric Surgery

Olga Karaseva, Anna Timofeeva, Alexander Gorelik, Denis Golikov

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma - Dr. Roshal's Clinic

Aim: To show the opportunities of laparoscopic technologies in diagnosis and treatment of abdominal cystic lymphangiomas in children.

Methods: Over the last 5 years 27 children were operated for abdominal cystic lymphangiomas. Boys:girls=1:1.5, mean age–8.5±5.3 years. In 66.7% children were hospitalized with acute appendicitis. Final diagnosis and surgical treatment were performed using laparoscopy.

Results: In 64.3% mesenteric lymphangiomas were diagnosed, in two children – lymphangioma of the omentum and in 4 – lymphangioma of the spleen. Complications were seen in 18.5%: bowel obstruction (2), ileum volvulus with bowel necrosis (1), partial twist with hemorrhage in to the cyst (2). Laparoscopy was performed in traditional technique (three trocars: 11 mm (optic) in umbilicus region, 5 mm (instruments) in left iliac region and in hypogastrium). To reduce the size of cystic cavities we puncture the large cysts under laparoscopy. If the cystic size is extremely big then percutaneous puncture under ultrasound is possible. In lymphangioma of the omentum a subtotal resection of the omentum was performed using ultrasonic dissector. In lymphangiomas of the mesentery the resection of the part of the bowel with adjacent cavities of lymphangiomas was performed. In 60% the resection of the intestine with formation of end-to-end anastomosis was performed laparoscopically, in 40% -- using minilaparotomy. No intraoperative complications were observed. The postop period was normal in all children. Histological examination confirmed the diagnosis. All children were on follow-up in 6 month – no recurrence observed.

Conclusion: In abdominal cystic lymphangiomas laparoscopy allows not only to confirm the diagnosis but also to manage the pathology in minimally invasive way.