WOFAPS 2025 8th World Congress of Pediatric Surgery

Maharram Guliyev ¹, Ali Ekber Hakalmaz ¹, Ceren Uç ², Ayşe Kalyoncu Uçar ³, Ahmet Baş ³, Süheyla Ocak ⁴, Rahşan Özcan ¹, Gonca Topuzlu Tekant ¹

¹ Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Department of Pediatric Surgery
² Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine
³ Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Department of Radiology
⁴ Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Department of Pediatric Haemotology and Oncology

Purpose: Treatment of lymphatic malformations is complex and the optimal approach between surgical excision and sclerotherapy remains debated. This study aims to evaluate long-term efficacy, safety and outcomes of intralesional bleomycin sclerotherapy in childhood lymphatic malformations.

Materials and Methods: Data from 96 patients who underwent intralesional bleomycin sclerotherapy for lymphatic (LM) and venolymphatic (VLM) malformations in our clinic between 2012 and 2024 were retrospectively analyzed. Patients were evaluated for demographic features, lesion morphology (macrocystic, microcystic, mixed), anatomical location, number of treatment sessions, complications, and recurrence rates. Treatment response was measured using a four-point clinical and radiological scoring system (0: no response, 1: minimal response, 2: significant improvement, 3: good response). Patients scoring 2 or 3 were considered responsive.

Results: The mean follow-up period for 96 patients (54 males, 42 females) was 78.5 months. A good response was observed in 64.6% and significant improvement in 27.5%, resulting in a total clinical success rate of 92.1%. Although macrocystic lesions required fewer injection sessions (p=0.013), there was no significant difference in final treatment response among cyst types. Lesions in the head and challenging areas like the tongue required more sessions and showed lower response rates. Five giant cervicofascial cases resulted in sepsis and death. Recurrence rate was 12.2%, with all recurrences responding well to repeat sclerotherapy. The complication rate was 19.8%, mostly local and temporary.

Conclusion: Intralesional bleomycin sclerotherapy is a safe and effective method with high success and low complication rates for treating childhood lymphatic malformations. Despite requiring more sessions in difficult anatomical areas, it should be considered a first-line treatment due to its efficacy and lower recurrence compared to surgery.